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05-3155 (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: CA 05-00003155 80237 VIA TESORO 772-250-019-51 -30357 - DWELLING - SINGLE FAMILY LOW DENSITY RESIDENTIAL 235565 Tiht 4 4 4" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: TOLL CA V C/O KEVIN D DUERMIT ATTACHED 8901 E MOUNTAIN VIEW 200 SCOTTSDALE, AZ 85258 �chitect or Engineer: RN M CRpuo SM t Tao ?_-5-7-74 --------------------------------------------------- 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 /Date. ' Zg Z 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).: (_ I 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.). (_) 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: `1 Lender's Address: N LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 D u^a u D AUG 2 2 2Q05 CITY OF LA QUINTA Contractor: `- TOLL BROS, INC. 73121 FRED WARING DRIVE, 4100 PALM DESERT, CA 92260 (760)674-9699 Lic. No.: 777699 ------------------- WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: _ 1 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. _K 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 LIBERTY MUTUAL Policy Number WA7.62D004723014 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. ate u�� icant: 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 Quints, 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. 1 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 property for inspection purposes. Date:af Signature (Applicant or Agent)' Application Number . . . . . 05-00003155 Structure Information Construction Type . . . . . TYPE V - 1 HR Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 Flood Zone . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 # BEDROOMS 2.00 FLOOD ZONE NO GARAGE SQ FTG 503.00 PATIO SQ FTG 173.00 TOT ELIGIBLE ivy NUMBER OF UNITS 1.00 2ND FLOOR SQUARE FOOTAGE 2694.00 ---------------------------------------------------------------------------- Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 1115.50 Plan Check Fee 181.27 Issue Date . . . . Valuation . . . . 235565 Expiration Date . . 1/18/06 Qty Unit Charge Per Extension BASE FEE 639.50 136.00 3.5000 THOU BLDG 100,001-500,000 476.00 ---------------------------------------------------------------------------- Permit . . . Additional desc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . MECHANICAL 90.00 1/18/06 Plan Check Fee . . 5.63 Valuation . . . . 0 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 5.00 6.5000 EA MECH VENT FAN 32.50 1.00 ---------------------------------------------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.50 Permit . . . Additional desc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . Qty . Unit Charge LQPERAIIT ELEC-NEW RESIDENTIAL 122.81 1/18/06 Per BASE FEE Plan Check Fee . . 7.68 Valuation . . . . 0 Extension 15.00 Application Number . . . . . 05-00003155 Permit . . . . . . ELEC-NEW RESIDENTIAL Qty Unit Charge Per Extension 2694.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 94.29 676.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 13.52 ---------------------------------------------------------------------------- Permit . . Additional desc . Permit Fee . . . Issue Date . . . Expiration Date . PLUMBING 183.00 1/18/06 Plan Check Fee . . 11.44 Valuation . . . . u Qty Unit Charge Per Extension BASE FEE 15.00 19.00 6.0000 EA PLB FIXTURE 114.00 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 7.5000 EA PLB .OTHER BACKFLOW <=2 INCH 7.50 8.00 .7500 EA PLB GAS PIPE >=5 6.00 1.00 15.0000 EA PLB GAS METER 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFA - PLAN TYPE C2 - UPPER FLOOR UNIT - 2694 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 REPETITION OF IDENTICAL PLAN TYPE. BLDG. 10, LOT 51 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 88.91 DIF COMMUNITY CENTERS -RES 68.00 DIF CIVIC CENTER - RES 229.00 ENERGY REVIEW FEE 18.13 DIF FIRE PROTECTION -RES 78.00 DIF LIBRARIES - RES 158.00 DIF PARK MAINT FAC - RES 3.00 DIF PARKS/REC - RES 352.00 STRONG MOTION (SMI) - RES 23.55 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged --------------------------- Paid Credited ------------------------------ Due LQPEn11T Application Number . . . . . 05-00003155 Permit Fee Total 1511.31 .00 .00 1511.31 Plan Check Total 206.02 .00 .00 206.02 Other Fee Total 2131.59 .00 .00 2131.59 Grand Total 3848.92 .00 .00 3848.92 LQPERMIT