05-3042 (SATT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
PrUP8ILy ZUnhly.
Application valuation:
Applicant:
,05-00003042
80255 VIA TESORO
772-250-019-34 -30357 -
DWELLING - SINGLE FAMILY
LOW DDNCITY PECIDENTIAL
195692
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:
R?4 M
C i to
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: VJ tractor: /
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt fromethe 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 Codel 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, 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—) 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: a 1pi
LQPERMIT
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
Date: 7/20/05
Li
AUG 2 1005
CITY pF i -A QUINTA
_FINAar,&
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.
—9.1 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.
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 fora 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 Ouinta, 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 ate laws relating to building construction, and hereby authorize representatives
of this county to enter upo a above-mentioned property for inspection p� oses.
r
te• ' '4 7—' O� gnature (Applicant or Agent):
Application Number . . 05-00003042
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
2.00
FLOOD ZONE
NO
GARAGE SQ FTG
901.00
PATTO SO FTG
156.00
TOT ELIGIBLE
NO
NUMBER OF UNITS
1.00
----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE
2110..00
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
975.50 Plan Check Fee
158.52
Issue Date . . . .
Valuation
195692
Expiration Date . .
1/16/06
Qty Unit Charge
Per
Extension
BASE FEE
639.50
96.00 3.5000
----------------------------------------------------------------------------
THOU BLDG 100,001-500,000
336:00
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
91.50 Plan Check Fee
5.72
Issue Date . . . .
Valuation . .
. . 0
Expiration Date . .
1/16/06
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
8.00 6.5000
EA MECH VENT FAN
52.00
1.00 6.5000
----------------------------------------------------------------------------
EA MECH EXHAUST HOOD
6.50
Permit . . .
ELEC-NEW RESIDENTIAL
Additional desc . .
Permit Fee . . . .
110.07 Plan Check Fee
6.88
Issue Date . . . .
Valuation . .
. . 0
Expiration Date . .
1/16/06'
Qty Unit Charge
Per
Extension
BASE FEE
15.00
LQPERMIT
Application Number . . . . . 05-00003042
Permit . . . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge Per
Extension
2110.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY
73.85
1061.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL
----------------------------------------------------------------------------
21.22
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 173.25 Plan Check Fee
10.83
Issue Date . . . . Vzluatinn
0
Expiration Date . . 1/16/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
16.00 6.0000 EA PLB FIXTURE
96.00
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
7.00 .75.00 EA PLB GAS PIPE >=5
5.25.
1.00 15.0000 EA PLB GAS METER
15.00
----------------------------------------------------------- ----------------
Special Notes and Comments
SFA - PLAN TYPE Al - GRND FLOOR UNIT
2,110 SF LIVING, R-3 OCCUPANCY, TYPE
V-1HR CONSTRUCTION, 2001 CODES. [PLAN
TYPE B2 GARAGE ATTACHED TO THIS PLAN
TYPE) **PERMIT DOES NOT INCLUDE TEMP
POWER, TRASH ENCLOSURE, BLOCK WALLS AND
SITE LIGHTING**
REDUCED PC FEES FOR REPETITION OF
IDENTICAL PLAN TYPE. BLDG. 8, LOT 34
----------------------------------------------------------------------------
Other Fees . . . . . . . . . DIF COMMUNITY CENTERS -RES
68.00
DIF CIVIC CENTER - RES
229.00
ENERGY REVIEW FEE
15.85
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
14.05
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
LQPERMIT
. . . . .
05-00003042
1350.32
.00
.00
1350.32
181.95.
.00
.00
181.95
2030.90
.00
.00
2030.90
3563.17
.00
.00
3563.17