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05-3500 (SFD)P.O. BOX 1504 44" VOICE 760 777-7012:, ' ( ) 78-495 CALLE TAMPICO FAX -(760) 777-701.1 LA QUI -NTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153- BUILD. 77-7153 BUILDING PERMIT Date: 8/08/05 Application Number: 05- 00003b.00 Owner:: Property Address:51590: VIA SORRENTO TOLL CA V APN: 772-250=997-148 -31349• C/O KEVIN D DUERMIT Application description: DWELLING - SINGLE FAMILY DETACHED 8901 .E MOUNTAIN VIEW 200 PPoperty Zoning: LOW DENSITY RESIDENTIAL SCOTTSDALE, AZ -85258 Application valuation: 261546 Contfactor: Applicant: /Architect or Engineer: TOLL BROS, INC. 73121 FRED WARING DRIVE, # PALM, DESERT,' CA 92260 JAN 0 2005 WCC: LIBERTY MUTUAL P.{, 1 L i c - No. B. CIYV. OF LA QUINTA. e" FINAF�CE"®EPY. LICENSED CONTRACTOR'S DECLARATION ' - - - - : WORKER'S COMPENSATION DECLARATION - 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:. Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for. workers' compensation, as provided : License Class: License No.: B - for by Section 3700 of the Labor Code, for the performance -of the work for which this permit is 2 issued. -' - �:�� Contractor: �� / � _• � . ' � � - ' - �I have and will maintain workers'. compensation insurance, as required by Section 3700 of the Labor �- - — - Code, for the performance of the work for which this permit is issued. My workers' compensation - OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier WA762DO04723014 09/01/06olicy Number 777699 following reason (Sec. 7031;.5, -Business and Professions,C,ode: Any city. or county that requires a permit to_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any - construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the - person in, ,any manner so as to become subject to the workers' compensation laws of California, -, - - .permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section _ - - License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code,1 shall forthwith comply with those provisions. , that he li she is exempt therefrom subjects theand. the app) cant to the alleged exemption.fnot than n fiveion of hundSection 7031.5 by - % ®� - - �A�- pf tea, „Q any applicant for a,permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.: ate: cant: �/ /��[,�/ r (__ 1 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, . SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES -AND CIVIL FINES UP TO ONE HUNDRED THOUSAND . and who does the work himself or herself through his or her own employees, provided that the - DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION.3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. one year of completion, the owner -builder will have the burden of .proving that he or she did not build or _ t - improve for the purpose of sale.). - - - - APPLICANT ACKNOWLEDGEMENT (_) I,.as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject. to the ' 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of - conditions and restrictions set forth on this application. - - - property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed - 1. Each person upon whose behalf this application is made,.each.person at whose request and for - pursuant to the Contractors' State License Law.). - . whose benefit work it performed under or pursuant to any permit issued as a result of this application, 1 _) I am exempt under'Sec. - , B.&P.C. for this reason - the owner, and the applicant, each agrees to, and shall.defend, indemnify 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. Date: Owner: - 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 CONSTRUCTION LENDING AGENCY _ -. - - permit to cancellation. - -I hereby affirm under penalty of perjury that there is a construction lending:agency for the performance of the.. - I certify that I have read this application and state that the above information'is correct. I agree to comply with all • - work for which this permit is issued (Sec. 3097, Civ: C.). - - cityLand county ordinances nd state laws relating to building construction, and hereby authorize representatives - of this county to enter n the above-mentioned ro ert for 'ns'�ction purp p p//�/i�//�Ap Lender's Name: .. ei / L�'!� c�� : ' Signature (Applicant or Agent): , Lender's Address: - - - - - LQPERMTf - - - - - Application Number 05-00003500 Structure Information Construction Type TYPE V - NON RATED Occupancy Type . . DWELLG/LODGING/CONG <=10 Flood Zone . . . NON -AO .FLOOD ZONE Other struct info . . . . . CODE EDITION2001,CBC # BEDROOMS.. 3.00 FIRE SPRINKLERS NO GARAGE SQ.FTG 625.00 PATIO SQ FTG 233.100 NUMBER OF UNITS 1.00, 1ST FLOOR SQUARE"FOOTAGE 3047.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 1206.50 Plan Check Fee 784.23 Issue Date Valuation 261546 Expiration Date .'. 2/04/06. Qty" Unit Charge Per Extension BASE FEE 639.50 162.00 3.5000 THOU BLDG"10.0,001-500,000 567.00 Permit MECHANICAL Additional desc . -Permit: Fee 127.50 - Plan Check Fee 31.88 Issue Date . . . Valuation . . . . 0 Expiration Date 2/04/06 Qty Unit Charge Per Extension BASE FEE 15:00 3.00 9.0000 EA" MECH <=100K 27.00 3.00 9.0000 .FURNACE EA MECH.B/C <=3HP/100K BTU' 27.00 8.00 6.5000 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 33.54, Issue'Date Valuation 0 Expiration Date 2/04/06 Qty Unit Charge Per ..Extension BASE'FEE 15.00 .3047.00. .0350 ELEC NEW RES - 1 OR 2 FAMILY 106.65 LQPERMIT - - 1. • ` Application Number 05-00003500 Permit ELEC-NEW RESIDENTIAL• Qty Unit Charge Per Extension 625.00 :0200 ELEC GARAGE OR NON-RESIDENTIAL 12:50. Permit , . PLUMBING - - Additional desc . Permit Fee 207.75 Plan Check. Fee 51.94 Issue Date Valuation .0 Expiration Date 2/04/06. Qty Unit Charge 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 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 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 Expiration -Date 2/04/06 Qty Unit Charge Per Extension -- BASE.FEE 15.00, --------------.-------------------------------------------_---------- 4. Special Notes"and Comments SFD - LOT 148. 3047 S-F.BELIZE-CONT. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL/SPA,OR DRIVEWAY APPROACH. -- - -------------------------.---------- Other Fees . . . . ART IN PUBLIC PLACES -RES 153.86 DIF COMMUNITY CENTERS -RES 97.00 " bIF CIVIC CENTER -RES 366:00 ENERGY REVIEW FEE 78.42 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 - LQPERMIT - :Application Number . . . . 05-00003500 ------------- Other Fees ------------ ---------------------- DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Paid Credited Due --- Permit Fee Total.- -----•----- •1690.90 ---- - - - - -- -- .00 -------.00 --- - - - - -- 1690.90. Plan Check.Total 901.59 _. .00 .00 901.59 Other Fee Total 2663.43. .00 .00 2663.43 Grand Total. 5255.92 .00 .00 5255.92 LQPERMIT _ -