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09-0167 (SFD)T4&t 4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 2/25/09 Application Number: 09-00000167 Owner: Property Address: 80124 VIA TESORO TOLL CA V APN: 772-250-018-5 -31349 - C/O KEVIN D DUERMIT Application description: DWELLING - SINGLE FAMILY DETACHED 8901 E MOUNTAIN VIEW 200 Property Zoning: LOW DENSITY RESIDENTIAL SCOTTSDALE, AZ 85258 Application valuation: 227594 Contractor: Applicant: Architect or Engineer: TOLL BROS, INC. MARO ^n� 73121 FRED WARING DRIV , 0 ' :U �� PALM DESERT, CA 92260 V1 (760) 674-9699 F14,V �F Lic. 777699 spy No.: ------------------------------------------------------------------------------------------------- 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 Licens Class: B License No.: 777699 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is y�. ,1L,, �o T ate: �-� " \ C ractor: �� ���/""r -J .1/C 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the Carrier ZURICH AMERICAN Policy Number WC3878213 - 03 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 fort rith 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).: e: Ap ' nt: 1 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 WARNING: FAILU E TO SECURE WORKERS MPENSATION 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 PEN 'TIES 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.). (_ 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 contractorls) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Ser.. , 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: LQPERM[T 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 county to enter upon the above-mentioned prop rty for inspectio purposes. �Sir. (Applicant or Agent): Application Number . . . . . 09-00000167 Permit . . . Additional desc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . Qty Unit Charge 2631.00 .0350 LQPERMIT ELEC-NEW RESIDENTIAL 116.99 Plan Check Fee . Valuation . . . . 8/24/09 Per BASE FEE ELEC NEW RES - 1 OR 2 FAMILY 29.24 0 Extension 15.00 92.09 Structure Information 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 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 706.88 Issue Date . . . . Valuation . . . . 227594 Expiration Date . . 8/24/09 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 27.40 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 8/24/09 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 Permit . . . Additional desc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . Qty Unit Charge 2631.00 .0350 LQPERMIT ELEC-NEW RESIDENTIAL 116.99 Plan Check Fee . Valuation . . . . 8/24/09 Per BASE FEE ELEC NEW RES - 1 OR 2 FAMILY 29.24 0 Extension 15.00 92.09 ah LQPERMIT Application Number . . . . . 09-00000167 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 Issue Date . . . . Expiration Date . . 8/24/09 Plan Check Fee . . 47.24 Valuation . . . . 0 Qty Unit Charge Per 15.00 ---------------------------------------------------------------------------- Special Notes and Comments Extension SFD - LOT 5. 2631 S.F.CAMINA-SB PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL/SPA, RA29 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 8/24/09 Plan Check Fee . Valuation . . . Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFD - LOT 5. 2631 S.F.CAMINA-SB PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL/SPA, OR DRIVEWAY APPROACH. 2007 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 68.98 BLDG STDS ADMIN (SB1473) 10.00 DIF COMMUNITY CENTERS -RES 74.00 DIF CIVIC CENTER - RES 995.00 ENERGY REVIEW FEE 70.69 DIF FIRE PROTECTION -RES 140.00 GRADING PLAN CHECK FEE .00 DIF LIBRARIES - RES 355.00 DIF PARK MAINT FAC - RES 22.00 DIF PARKS/REC - RES 892.00 STRONG MOTION (SMI) - RES 22.75 Application Number . . . . . 09-00000167 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . DIF STREET MAINT FAC -RES 67.00 DIF TRANSPORTATION - RES 1930.00 Fee summary ----------------- Charged ---------- Paid ---------- Credited -------------------- Due Permit Fee Total 1517.99 .00 .00 1517.99 Plan Check Total 810.76 .00 .00 810.76 Other Fee Total 4647.42 .00 .00 4647.42 Grand Total 6976.17 .00 .00 6976.17 LQPERMIT