05-2847 (SFD). t D.
P.O. BOX 1504 ,
78-495 CALLE TAMPI
LA QUINTA,'CALIFO I
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
,SEP 0 � 2005 .
!25 OF XQU11401
C1T� , e�cED�i
05-0000-2547 J
51686 VIA SORRENTO_
772-250-997-152 -31349 -
DWELLING - SINGLE FAMILY
LOW DENSITY RESIDENTIAL
227594
BUILDING & SAFETY -DEPARTMENT
BUILDING PERMIT
Owner:
TOLL CA V
C/O KEVIN D DUERMIT
DETACHED 8901 E MOUNTAIN VIEW 200
SCOTTSDALE, AZ 85258
,.__�rchitect or Engineer:
Contractor:
TOLL BROS, INC.
73121 FRED WARING DRIVE, #100
PALM DESERT, CA 92260
WCC:. LIBERTY MUTUAL
Lic. No.: B
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/11/05
-------------------------------- I - - - - - - - - - - - - - - - ------------------------------------- - - - - --
' LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION -
I 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 Cl s: License No.: B
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
2J�!'� r /
/late: � - "' ontractor: B L `1 ✓Y ` _
issued.
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
r
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 Code: 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 a6ree that, if Ishould become subject to the workers' compensation provisidns 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, I shall forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by0
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55001:
ate: g'Z cant: ��<< �^w jaL
(_ 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'70 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 1$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
improve for the purpose of sale.).
(_ 1 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.). .�.
( ) I am exempt under Sec. , B.&P.C. for this reason -
Date:
Owner:
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: .
LQPERAIIT
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, indemnify and hold harmless the'City
of La Quinta, 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. I agree to comply with all
city and county ordinances and state laws relating to building construction,. and hereby authorize representatives
of this cou ty o enter upon the above-mentioned property for inspection purposes.
Dater =' iQpdrure (Applicant or Agent):
Application Number
05-00002847
Structure Information
• Construction Type
TYPE V - NON RATED
= Occupancy Type
DWELLG/LODGING/LONG <=10
Flood Zone .
. . . NON -AO FLOOD ZONE
Other s.truct info :
CODE EDITION
2001 CBC }
# BEDROOMS
3.00..
=
FIRE`SPRINKLERS
NO
GARAGE SQ FTG
495.00
PATIO SQ 'FTG
399.00
NUMBER -OF UNITS
.1.00
1ST FLOOR SQUARE FOOTAGE
2631.00
Permit
BUILDING PERMIT
Additional desc .
- Permit-Fee
10.87.50 Plan Check Fee
176.72
Issue Date
Valuation
227594
-Expiration-Date
.1/07/06
Qty Unit Charge
Per
Extension
BASE FEE
639.50,
128:00 3.5000
THOU BLDG 100,001-500;000
448:.00.
Permit . . .
MECHANICAL
Additional desc _
Permit Fee
.109.50, Plan Check Fee
.6.85
Issue'Date
Valuation . . .
. 0
Expiration Date
1/07/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00,
2.00 9.0000
EA' MECH FURNACE <=100K
18:00 .
2.00 9.0000
EA MECH B/C <=3HP/1.00K BTU
18.0.0
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
116.99 Plan Check Fee
7.31.
Issue Date
Valuation . .
0
Expiration Date
1/07/06
Qty Unit .Charge
Per
Extension
BASE FEE
15.00
2631.00 ..0350
ELEC NEW RES - 1 OR 2 FAMILY
92.09
LQPERMTf
Application Number 05-0000284.7
Permit - ELEC-NEW RESIDENTIAL•
Qty Unit Charge Per
Extension
: 4.95:00 .0200 ELEC GARAGE OR NON-RESIDENTIAL
9.90
Permit . . PLUMBING
f Additional des_c .
Permit Fee 189.00 Plan Check Fee
11.81
-Issue Date .Valuation . . .
0
Expiration Date 1/07/06 .
Qty. Unit Charge Per
Extension
BASE FEE __
15-00
20.00 6.0000 EA PLB FIXTURE
120.00
1.00 15.0000 EA PLB BUILDING SEWER
15.00
1.00 7..5000 EA PLB WATER HEATER/VENT
7.50
h 0 0 3.0000 EA PLB WATER INST/ALT/REP
3,-00
1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM
9.00.
6.00 .7500 EA PLB GAS PIPE >=5
4.50
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
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------
Special Notes and Comments
SFD - LOT 152. 2631 S.F.CAMINA-CONT,
PERMIT DOES NOT INCLUDE BLOCK WALLS-,
POOL/SPA,OR DRIVEWAY APPROACH..75o PLAN
- CHECK'FEE REDUCTION APPLIED FOR _
'MULTIPLE ISSUANCE OF SAME PLAN TYPE:
-----------------------------------------------------
Other Fees . . . . . . . . ART IN PUBLIC PLACES -RES
68.98
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
17.67
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 :
C
502.00
- . LQPERD4IT -
Application Number
05-00002847
----
Other Fees
------,------
--------------------------
-
STRONG MOTION (SMI) RES
----------- ---
22.75
,DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary
Charged
Paid Credited
Due
Permit Fee Total
- -------
1517.99
---------- ---------- ----------
.00 .00
1517.99
Plan Check Total
202.69
.00 .00.
202.69
' Other Fee,Total
2514.40
.00 .00
2514.40
Grand Total
4235.08
.00 .00
4235.08
LQPE"11T ..
-