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05-2685 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA; CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant:: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT X0.5-000U2685� 51677 VIA SORRENTO. 77.2-250-997-77 -31349.- DWELLING - SINGLE FAMILY:DETACHED LOW DENSITY RESIDENTIAL 261546 /Arc VOICE (760)777-7012 FAX (760) 777-7011 : INSPECTIONS (760) 777-7153 Date: 6/30/05 Owner: TOLL CA V C/O KEVIN D DUERMIT 8901 E MOUNTAIN VIEW 200 SCOTTSDALE, AZ 85258 Contractor: TOLL BROS, INC. .73121 FRED WARING DRIVE, #100 PALM DESERT, CA 92260 WCC: LIBERTY MUTUAL Lic. No.: B ------------- ---------------------------------------------- LICENSED CONTRACTOR'S DECLARATION - ---------------------------- ----------- WORKER'S COMPENSATION DECLARATION 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-evhich this permit is sw� r - ' � r& L issued. �I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Date: ontractor: si W _ �- •- 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 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, 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 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred. dollars:($ 500).: scant: ( 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 ' improve for the purpose of sale.l. - APPLICANT ACKNOWLEDGEMENT ( 1 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 restrictionsset 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 is performed under or pursuant to any permit issued as aresult 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 Quinta, its officers, agents and employees for any -actor 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. 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.). city and county, ordinances and state laws relating to building construction, and hereby authorize representatives ' of this county po inter upon the,above-mentioned property fo�ection purposes. Lender's Name: e�1 / Z te: 0 ature Applicant or Agent): �I Lender's Address: LQPERMIT Application Number 05-00002685 Structure Information Construction Type . . . TYPE V - NON RATED Occupancy -Type. . . . . DWELLG/LODGING/CONG <=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 3047..00 Permit . . . BUILDING PERMIT Additional. desc . Permit Fee . . 1206.50 Plan Check Fee 784.23 - Issue Date Valuation . . . . 261546 Expiration Date 12/27/05 Qty .-Unit Charge Per. Extension 'BASE FEE 639.50 162.00` 3.5000 ----------------------------------------------------------------------------- THOU BLDG.100,,001-500,000 567.00 Permit MECHANICAL Additional desc . Permit Fee . . . . 127.50 Plan'Check Fee 31.:88 Issue Date _ Valuation 0 Expiration Date 12/27/05. ' Qty Unit Charge Per Extension BASE FEE 15.00 - 3.00 9.0000 EA. MECH FURNACE r=100K 27.00 3.00 9.0000 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 12/27/05 Qty Unit Charge Per Extension BASE FEE 15.00 3047.00 .035,0 ELEC NEW RES - 1 OR 2 FAMI-LY 106.65 LQPER %IIT . . Application Number 05-00002685 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 12/27/05 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 12/27/05 _ Qty Unit Charge Per Extension BASE FEE 15.00 Special. Notes and Comments SFD'- LOT 77. 3047 S.F.BELIZE-SB. 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 DIF 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 • LQPERAiTT ` .. Application Number . . . 0.5700002685 ---------------------- Other Fees DIF.TRANSPORTATION RES i098.00 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 -, LQPERMTT '- ..