05-3147 (SATT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
05-00003147
80235 VIA TESORO
772-250-019-50 -30357 -
DWELLING - SINGLE FAMILY
LOW DENSITY RESIDENTIAL
199102
Ti1tt 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
TOLL CA V
C/O KEVIN D DUERMIT
ATTACHED 8901 E MOUNTAIN VIEW 200
SCOTTSDALE, AZ 85258
/rchitect or Engineer:
C2�►Lto S�t'�
Z3�
LICENSED CONTRACTOR'S DECLARATION
I 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: B License No.: 777699
DateV- Contractor:
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).:
(_) 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 I as nwnar of tha prnparty, am nxrl i—ly nnn.rpotiprd 4rith liuonuud ountrubre to aanatruat tha Nroio.,l (0.,.,.
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:
LQPER111IT
Contractor:
TOLL BROS, INC.
73121 FRED WARING DRIVE, #100
PALM DESERT, CA 92260
(760)674-9699
Lic. No.: 777699
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
7/22/05
De
rAUG 22 2005 F9)
CITY OF P.A Q IU NTA
F11une...� _ _
WORKER'S COMPENSATION DECLARATION
1 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
M . issued.
J� 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 LIBERTY MUTUAL Policy Number WA762DO04723014
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, I shall forthwith comply with those provisions.
r
ErSte:�ZZ pplicant:
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
IMPanTANT Applluaduu Is heieby made Lu Me UIIeCWI ui ouuuoly anu safety tar a permit SU1518tl 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 toee�nt//
�er upon the above-mentioned property for inspection purposes.
pate:.VaKe (Applicant or Agent):
Application Number . . . . . 05-00003147
Structure Information
Construction Type . .
. . . TYPE V - 1 HR
Per
Occupancy Type . . .
. . . DWELLG/LODGING/CONG <=10
Flood Zone . .
. . . NON -AO FLOOD ZONE
FEE
Other struct info . .
. . . CODE EDITION
2001
EA MECH
# BEDROOMS
2.00
1.00
FLOOD ZONE
NO
B/C <=3HP/100K BTU
GARAGE SQ FTG
532.00
6.5000
PATIO SQ FTG
132.00
26.00
TOT ELIGIBLE
NO
EA MECH
NUMBER OF UNITS
1.00
----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE
2252.00
Permit . . .
BUILDING PERMIT
Additional desc . .
Permit Fee
Permit Fee . . . .
919.50 Plan Check Fee
149.42
Issue Date . . . .
Valuation . .
. . 179781
Expiration Date . .
1/18/06
. 0
Qty Unit Charge
Per
Extension
BASE FEE
639.50
80.00 3.5000
----------------------------------------------------------------------------
THOU BLDG 100,001-500,000
280.00
Permit . . .
MECHANICAL
Additional desc . .
FEE
15.00
Permit Fee . . . .
65.50 Plan Check Fee
4.10
Issue Date . . . .
Valuation
0
Expiration Date . . 1/18/06
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
1.00
9.0000
EA MECH
FURNACE <=100K
9.00
1.00
9.0000
EA MECH
B/C <=3HP/100K BTU
9.00
4.00
6.5000
EA MECH
VENT FAN
26.00
1.00
----------------------------------------------------------------------------
6.5000
EA MECH
EXHAUST HOOD
6.50
Permit
ELEC-NEW RESIDENTIAL
Additional
d000 . .
Permit Fee
. . . .
107.10
Plan Check Fee
6.70
Issue Date
. . . .
Valuation . . .
. 0
Expiration
Date . .
1/18/06
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
LQPERMIT
Application Number . . . . 05-00003147
Permit . . . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge Per
Extension
2252.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
78.82
664.00 .0200
----------------------------------------------------------------------------
ELEC GARAGE OR NON-RESIDENTIAL
13.28
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 178.50
Plan Check Fee
11.16
Issue Date . . . .
Valuation . . . .
0
Expiration Date . . 1/18/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
17.00 6.0000 EA
PLB FIXTURE
102.00
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
1.00 7•.5000 EA
PLB OTHER BACKFLOW <=2 INCH
7.50
6.00 .7500 EA
PLB GAS PIPE >=5
4.50
1.00 15.0000 EA
PLB GAS METER
15.00
----------------------------------------------------------------------------
Special Notes and Comments
SFA - PLAN TYPE C1 - GROUND
FLOOR UNIT -
2252 SQ.FT. LIVING, R-3 OCCUPANCY,
TYPE
V- 1HR CONSTRUCTION, 2001 CODES.
**PERMIT DOES NOT INCLUDE TEMP
POWER ,
TRASH ENCLOSURE, BLOCK WALLS
AND SITE
LIGHTING**
REDUCED PC FEES FOR
REPITITION OF IDENTICAL PLAN
TYPE.
BLDG. 10, LOT 50
----------------------------------------------------------------------------
Other Fees . . . . . . . .
. DIF COMMUNITY CENTERS -RES
68.00
DIF CIVIC CENTER - RES
229.00
ENERGY REVIEW FEE
14.94
DIF FIRE PROTECTION -RES
78.00
DIF LIBRARIES - RES
158.00
DIF PARK MAINT FAC - RES
3.00
DTF PARKS/`REC - RES
Jb2 . UU
STRONG MOTION (SMI) - RES
19.91
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary Charged
---------------------------
Paid Credited
------------------------------
Due
LQPERMIT
Application Number
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
LQPERMTT
. . . . . 05-00003147
1270.60 .00 .00 1270.60
171.38 .00 .00 171.38
2035.85 .00 .00 2035.85
3477.83 .00 .00 3477.83