05-3037 (SATT)Ei•
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
05-00003037
80254 VIA TESORO
772-250-019-29 -30357 -
DWELLING - SINGLE FAMILY
LOW DENSITY RESIDENTIAL
. 244630
Ta�v 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
architect or Engineer:
QMN
GRAt6 SMTT10
z.'31 -7q
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that Iam 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
J/ 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 _ 1 1, 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 ISec. 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 _ 1 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: 1 44
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
l�J
Contractor:
TOLL BROS, INC.
73121 FRED WARING DRIVE, #00
PALM DESERT, CA 92260
(760)674-9699
Lic. No.: 777699
Date: 7/20/05
AUG 2 21E�5 r.
CITY of A �tiIN7A
_FINAA►r�
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.
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
1 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�Laborode, I shall forthwith comply with those provisions.
Erate�ZZ—Oi
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 thiscountyto enter upon the above-mentioned property for inspection purposes.
pa"r. -21,09 we IApplicant or Agent):
Application Number . . . . . 05-00003037
Structure Information
Construction Type . . . . . TYPE V - 1 HR
Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10
Flood Zone . . . . . NON -AO FLOOD ZONE
Other struct info . . . . . CODE EDITION 2001
# BEDROOMS 3.00
FLOOD ZONE NO
GARAGE SQ FTG 547.00
PATIO SQ FTG 418.00
TOT EL' iGiBLE 1110
NUMBER OF UNITS 1.00
2ND FLOOR SQUARE FOOTAGE 2748.00
----------------------------------------------------------------------------
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 1147.00
Issue Date . . . .
Expiration Date . . 1/16/06
Plan Check Fee . . 745.55
Valuation . . . . 244630
Qty
Unit Charge
Per
Extension
BASE
FEE-
639.50
145.00
----------------------------------------------------------------------------
3.5000
THOU BLDG
100,001-500,000
507.50
Permit
. . . MECHANICAL
.Additional
desc . .
Permit Fee
. . . .
116.00
Plan Check Fee
29.00
Issue Date
. . . .
Valuation
0
Expiration
Date
1/16/06
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
9.00
6.5000
EA MECH
VENT FAN
58.50
1.00
----------------------------------------------------------------------------
6.5000
EA MECH
EXHAUST HOOD
6.50
Permit . . . ELEC-NEW RESIDENTIAL
Additional desc . .
Permit Fee . . . . 130.48 Plan Check Fee .
Issue Date . . . . Valuation . . . .
Expiration Date . . 1/16/06
Qty Unit Charge Per
BASE FEE
LQPERMIT
32.62
0
Extension
15.00
Application Number . . . . . 05-00003037
Permit . . . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge Per Extension
2748.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 96.18
965.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 19.30
----------------------------------------------------------------------------
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 183.75
Issue Late . . . .
Expiration Date . . 1/16/06
Plan Check Fee . . 45.94
Valuation . . . . 0
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
9.00
.7500 EA PLB GAS PIPE >=5
6.75
1.00
15.0000 EA PLB GAS METER
15.00
----------------------------------------------------------------------------
Special Notes
and Comments
SFA -BLDG. 7,
LOT 29 PLAN TYPE A2 -
UPPER FLOOR
UNIT -2748 SF
LIVING, R-3 OCCUPANCY,
TYPEV-1HR CONSTRUCTION,
2001 CODES.
**PERMIT DOES
NOT INCLUDE TEMP. POWER,
TRASH ENCLOSURE, BLOCK WALLS AND SITE
LIGHTING**
----------------7-----------------------------------------------------------
Other Fees .
. . . . . . ART IN PUBLIC PLACES -RES
111.57
DIF COMMUNITY CENTERS -RES
68.00
DIF CIVIC CENTER - RES
229.00
ENERGY REVIEW FEE
74.56
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
23.83
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary
-----------------
Charged Paid Credited
----------
Due
Permit Fee Total
------------------------------
1577.23 .00 .00
1577.23
Plan Check Total
853-.11 .00 .00
853.11
LQPERMIT
Application Number
Other Fee Total
Grand Total
LQPERMTT
. . . . . 05-00003037
2210.96 .00 .00 2210.96
4641.30 .00 .00 4641.30