09-1300 (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:
09-00001300
80237 VIA TESORO
772-250-019-51 -30357 -
DWELLING - SINGLE FAMILY
LOW DENSITY RESIDENTIAL
235565
Tiht etP Q
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r
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/29/09
Owner:
TOLL CA V
C/O KEVIN D DUERMIT
ATTACHED 8901 E MOUNTAIN VIEW 200
SCOTTSDALE, AZ 85258
Architect or Engineer
P/Pr
OA
0 nil
c
APR 0 2010 ]J
CITY OF !.A OUINVA
---------------------------------------------------
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 g Liice�nse No.: 777699
ate:7 — ractor:
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 1, 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Contractor:
TOLL BROS, INC.
73121 FRED WARING DRIVE, #100
PALM DESERT, CA 92260
(760)674-9699
Lic. No.: 777699
------------------
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 ZURICH AMERICAN Policy Number WC3878213-03
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.
, date - b /
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 county to enter upon a above-mentioned prop rty for inspection urposes.
'bate: `fid gnature (Applicant or Agent):
Application Number . . . . . 09-00001300
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 2007
# BEDROOMS
2.00
FLOOD ZONE NO
GARAGE SQ FTG
503.00
PATIO SQ FTG
173.00
TOT ELIGIDLE 11O
NUMBER OF UNITS
1.00
----------------------------------------------------------------------------
2ND FLOOR SQUARE FOOTAGE
2694.00
Permit . . . ELEC-NEW RESIDENTIAL
Additional desc .
Permit Fee . . . .
122.81 Plan Check Fee
30.70
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
6/27/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2694.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
94.29
676.00 .0200
----------------------------------------------------------------------------
ELEC GARAGE OR NON-RESIDENTIAL
13.52
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . .
1115.50 Plan Check Fee
725.08
Issue Date . . . .
Valuation . . . .
235565
Expiration Date
6/27/10
Qty Unit Charge
Per
Extension
BASE FEE
639.50
136.00 3.5000
----------------------------------------------------------------------------
THOU BLDG 100,001-500,000
476.00
Permit . . .
MECHANICAL
Additional desc . .
Permit Fee . . . .
90.00 Plan Check Fee
22.50
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
6/27/10
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
LQPEnlIT
Application Number . . . . 09-00001300
Permit . . . . . . MECHANICAL
Qty Unit Charge Per Extension
5.00 6.5000 EA MECH VENT FAN 32.50
1.00 6.5000 EA MECH EXHAUST HOOD 6.50
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Permit . . . . . PLUMBING
Additional desc .
Permit Fee . . . . 183.00 Plan Check Fee 45.75
issue Daae . . . . Valuation . . . . 4
Expiration Date 6/27/10
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, 2007 CODES. **PERMIT
DOES NOT INCLUDE TEMP POWER, TRASH
ENCLOSURE, BLOCK WALLS AND SITE
LIGHTING** BLDG. 10, LOT 51
THIS PERMIT REPLACES EXPIRED PERMIT #
05-3155,ISSUED ON 8/22/05 BUT NEVER
BUILT.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 10.00
ENERGY REVIEW FEE 72.51
STRONG MOTION (SMI) - RES 23.55
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 1511.31 .00 .00 1511.31
Plan Check Total 824.03 .00 .00 824.03
Other Fee Total 106.06 .00 .00 106.06
Grand Total 2441.40 .00 .00 2441.40
LQPERMIT