05-2846 (SFD)Applicant: �rchitect or Engineer:
C
ING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: License No.: B
ate:�� Or ntractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ ) I, 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 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.).
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:
LQPERA11T
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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/11/05
-----------------------------------------------
WORKER'S 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.
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
insurance carrier and policy number are:
Carrier WA762DO04723014 09/01/06olicyNumber 777699
I certify that, in the performance of the work for 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, IIsshall forthwith comply withthoseprovisions.
ate: 7��r pplicant: r 0
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.
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 y to enter up he above-mentioned proper for inspection.purposes.
11
Date: 2 OJ ignature (Applicant or Agent):
P.O. BOX 1504
78-495 CALLE TAMPIC0 SEP 06 2005
LA QUINTA, CALIFORNIA12 3
of �QUIN7A i
C17Y
ftINANCE
Application Number:
05-00002846
Property Address:
51797 VIA SORRENTO
APN:
772-250-997-72 -31349 -
Application description:
DWELLING - SINGLE FAMILY DETACHED
Property Zoning:
LOW DENSITY. RESIDENTIAL
Application valuation:
227594
Applicant: �rchitect or Engineer:
C
ING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: License No.: B
ate:�� Or ntractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ ) I, 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 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.).
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:
LQPERA11T
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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/11/05
-----------------------------------------------
WORKER'S 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.
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
insurance carrier and policy number are:
Carrier WA762DO04723014 09/01/06olicyNumber 777699
I certify that, in the performance of the work for 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, IIsshall forthwith comply withthoseprovisions.
ate: 7��r pplicant: r 0
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.
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 y to enter up he above-mentioned proper for inspection.purposes.
11
Date: 2 OJ ignature (Applicant or Agent):
Application Number . . . . . OS -00002846
. . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
Qty Unit Charge
2631.00 .0350
LQPEnIrT
ELEC-NEW RESIDENTIAL
116.99 Plan Check Fee .
Valuation . . .
1/07/06
Per
BASE FEE
ELEC NEW RES - 1 OR 2 FAMILY
7.31
0
Extension
15.00
92.09 •
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
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
1087.50 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/100K BTU
18.00
8.00 6.5000
EA MECH VENT FAN
52.00
1.00 6.5000
--------------------- :
EA MECH EXHAUST HOOD
6.50
. . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
Qty Unit Charge
2631.00 .0350
LQPEnIrT
ELEC-NEW RESIDENTIAL
116.99 Plan Check Fee .
Valuation . . .
1/07/06
Per
BASE FEE
ELEC NEW RES - 1 OR 2 FAMILY
7.31
0
Extension
15.00
92.09 •
Application Number . . . . 05-00002846
Permit . . . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge
Per
Extension
495.00
----------------------------------------------------------------------------
.0200.
ELEC GARAGE OR NON-RESIDENTIAL
9.90
Permit
. . .
PLUMBING
Additional
desc .
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
1.00
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 .
Additional desc
Permit Fee
Issue Date
Expiration Date
GRADING PERMIT
15.00
1/07/06
Plan Check Fee .00
Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
----------------------------------------------------------------------------
Special Notes and Comments
SFD - LOT 72. 2631 S.F.CAMINA-CONT.
PERMIT,DOES NOT INCLUDE BLOCK WALLS,
POOL/SPA,OR DRIVEWAY APPROACH. 75% 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 502.00
LQPERMIT
Application Number . . . . . 05-00002846
----------------------------------------------------------------------------
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
a
LQPERMIT