04-8075 (SFD)0 0
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BUILDING & SAFETY DEPARTMENT
P.O. Box 1504
(760).777-7012
C��1pF9 78-495 CALLE TAMPICO FAX (760) 777-7011
LA,QU,INTA, CALIFORNIA 92253. INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number 400008075 Date 1/12/05
Property Address 5"581 VIA SC
Property
APN. 772-250-997.-81 -3.1349 -
Application description DWEL"LING,- SINGLE FAMILY DETACHED
Property Zoning . . . LOW DENSITY RESIDENTIAL
Application valuation . . . 262610
Owner Contractor,
---------------------------------7.-==----=----.-------=---.------ ---
TOLL CA V TOLL BROS, INC.
C/O KEVIN.D DUERMIT 73121 FRED WARING DRIVE, #100
,8901 E MOUNTAIN VIEW 200 PALM DESERT, CA 92260`
SCOTTSDALE,,AZ"85258 WCC: MARSH USA INC.
WC: WA762DO04723014 09/0.1/05
CSLB: 777699. 04/30/06
CCC: B:
MAY 12 1005
CITY OF LA QUIPITA
FIN AWCE DEPT
P.O. Box 1504 • ����
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: o4— IRU75- Date: /2 •os'
Applicant: Arc cA pr rigineeinc ( j ,t
Applicant's Mailing Address:
or Engineer% Address:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirmand r penalty of pedury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Co nd my Lic s is in full force and effect.1./,
cense Class icense No..7�776 9 `7
5')
M
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the -work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner.
WORKERS' COMPENSATION DECLARATION,..',
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
have and will maintain workers' compensati?D insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
,/y� iss ed. ompensatio<,n
ce cam r n y n r re: r1
Cartier 1 � 4 c Number p�fe i Zn�/ a130ly
I certify that, in the performance o thfor which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
157K/05—
WARNING:
Ste
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Ouinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building
c
onstruction, and hereby authorize re resentatives of this county to ent r u on the above-mentioned property for inspection purposes.
�� Signature (Applicant or Agent):
Application Number .
.'. . 04-00008075
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°�1` Structure Information .,
mat.ion
Construction Type . .
. . .. TYPE V - NON RATED
Occupancy -Type
. . .
. . . DWELLG/LODGING/LONG <=10
Flood Zone . .
. . .
. . . NON -AO FLOOD ZONE
Other struct info . .
. . . CODE EDITION 2001 CBC
# BEDROOMS
.3.00
FIRE SPRINKLERS• NO
GARAGE SQ FTG
625.00
PATIO SQ FTG
233.00
NUMBER OF UNITS
1.00
1ST FLOOR SQUARE FOOTAGE
.3.047.00':.
Permit
BUILDING PERMIT
Additional desc
Permit Fee
1210.00 Plan Check Fee'.
196.63,
Issue Date
. .
Valuation
262610.
Qty 'Unit,Charge
Per
Extension
BASE FEE
639.50
163.00
3.5000
THOU -BLDG 100,001-500,000
.570.50
Permit . . . .
. .
MECHANICAL
Additional desc
Permit Fee
127.50 Plan Check Fee
7.97.
Issue, Date
Valuation.
0
' Qty Unit
Charge
Per
Extension
BASE FEE
15.00
3.00
9.0000
EA MECH FURNACE <=100K
27.00
3.00
9.0000
EA MECH,B/C.<=3HP/100K BTU
27."00
8.00
6-.500:0
EA MECH.VENT FAN
52.00
1.00
6.5000
EA MECH EXHAUST HOOD
6.50
Permit . . .
ELEC-'NEW,RESIDENTIAL
Additional desc
Permit Fee . .
. .
134.15-. Plan Check.Fee..
8.39
Issue Date
Valuation . .
0
Qty Unit
Charge
Per
Extension
BASE FEE
15.00
3047.-00
0350
ELEC NEW RES - 1 OR 2 FAMILY
106.65
625.00
.0200
ELEC GARAGE OR NON-RESIDENTIAL
12.50
Permit . . .
PLUMBING
Additional desc
Permit Fee . .
.
207.75. Plan Check Fee
12.99
Issue Date
Valuation
0
Qty. Unit.
Chargee
Per
Extension
BASE FEE'
15.00
23.00
6:0000
EA PLB FIXTURE
138.00
1.00 15.0000
EA PLB'BUILDING SEWER
15.00
1.00
7.5000
EA PLB WATER HEATER/VENT
.7.5.0
1.00
3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00
9.0000
EA, PLB LAWN SPRINKLER SYSTEM
9.00
r
z, A%pplication Number. 04-00008075
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Permit . . . . . PLUMBING
Qty Unit Charge Per
Extension
7.00 .7500 EA PLB GAS PIPE >=5
- 5.25
1.00 15:.0000 EA PLB GAS METER
15.00
Permit .. . . . . . GRADING PERMIT
Additional desc
Permit Fee 15.00 Plan Check Fee
.00
Issue Date Valuation . . .
. 0
Qty .Unit Charge Per
Extension
BASE FEE
15.00'
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Special Notes and Comments
SFD - LOT 81. 3047 S.F. SFD. BELIZE/SB
+4. PERMIT DOES NOT INCLUDE
BLOCKWALLS,POOL/SPA,OR DRIVEWAY
APPROACH. 75% REDUCTION TO PLAN CHECK
FEE DUE TO MULTIPLE ,ISSUANCE OF SAME
PLAN TYPE
--------------------------------=-----------------------------
Other Fees . . . ... . . . . ART IN PUBLIC PLACES -RES
---
153.86
DIF,COMMUNITY CENTERS -RES
97.00'
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
19.66
DIF FIRE PROTECTION -RES
97.00
GRADING PLAN'CHECK FEE
.00
DIF LIBRARIES - RES
225.00
DIF PARK MAINT FAC - RES
5.00
DIF PARKS/REC - RES
502.00
STRONG MOTION (SMI),- RES
26.15
DIF STREET MAINT FAC -RES
15.00.
DIF TRANSPORTATION - RES
109'8.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 1694.40 .00 .00
1694'.40
Plan Check Total 225.98 .00 .00
225.98
Other Fee Total 2604.67 .00 .00°
2604.67
Grand Total 4525.05 :00 .00
4525.05