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05-2652 (SATT)`-P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: 05-00002652 80261 VIA TESORO 772-250-019-26 -30357 - DWELLING - SINGLE FAMILY LOW DENSITY RESIDENTIAL 195262 T,itit 4 4 Q" BUILDING & SAFETY DEPARTMENT BU ING PERMIT OOwner: 4 TOLL CA V C/O KEVIN D DUERMIT ATTACHED `�{/� 8901 E MOUNTAIN VIEW 200 16JO 'UTT.YDAL9, A2 85258 — t—t„r- rchitect or Engineer: BK�fo -02377 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I a licensed under provision f Chapter 9 (commencing with Section 7000) of Division 3 of the Business a Professionals Code, an y License is in full force and effect. License C ss: B cense No . 777699 ..,%_ o �le5 / Date: V14412Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of pe ury 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 _) 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 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.). (_) 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 contractorls) licensed pursuant to the Contractors' State License Law.). (_ 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 ISec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT 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: 6/29/05 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 arc: Carrier LIBERTY MUTUAL /th-orulmfor Nber WA762D0047 3014 I certify that, in the performance owhchthis permit i ssued, I shall not employ any person in any manner so as to bsubject to the workers' ompensation laws of California, and agree that, if I should becoject to the workers' pensation provisions of Section M700 of the Labor Code sh f ith provisions. Date: ZU lJ45�plicant: WARNING: FAILURE TO SECURE W RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL 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 comment within 180 days from date of issuance of such permit, or., ssation of work for 180 days subject permit to cancellation. 1 certify that I have read this application and state that the above info inion is correct. I agree to ply with all city and county ordinances and state laws relating to building const ' n, and hereby auth ives of this co my t ent pon the above-mentioned property for ' s r sate: ignature (Applicant or Agent): Application Number . . . . . 05-00002652 Permit . . . ELEC-NEW RESIDENTIAL Additional desc . . Permit Fee . . . . 105.07 Plan Check Fee . Issue.Date . . . . Valuation . . . . Expiration Date . . 12/26/05 Qty Unit Charge Per BASE FEE LQPERMIT 26.27 0 Extension 15.00 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 495.00 PATIO SQ FTG 132.00 TOT ELIGIBLE NO NUMBER OF UNITS 1.00 ---------------------------------------------------------------------------- 2ND FLOOR SQUARE FOOTAGE 2215.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 975.50 Plan Check Fee 634.08 Issue Date . . .. Valuation. 195262 Expiration Date ... 12/26/05 Qty Unit Charge Per Extension' BASE FEE 639.50 96.00 3.5000 ------------------------------------------------------------7--------------- THOU BLDG 100,001-500,000 336.00 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 65.50 Plan Check Fee 16.38 Issue Date . . . . Valuation. 0 Expiration Date 12/26/05 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 desc . . Permit Fee . . . . 105.07 Plan Check Fee . Issue.Date . . . . Valuation . . . . Expiration Date . . 12/26/05 Qty Unit Charge Per BASE FEE LQPERMIT 26.27 0 Extension 15.00 Application Number . . . . . 05-00002652 Permit . . . . . .. ELEC-NEW RESIDENTIAL Qty Unit Charge Per Extension 2215.00 .0350 ELEC NEW RES -.1 OR 2 FAMILY 77.53 627.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 12.54 ---------------------------------------------------------------------------- Permit . Additional desc Permit Fee Issue Date Expiration Date . PLUMBING 178.50 Plan Check Fee . . 44.63 Valuation . . . . 0 12/26/05 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 D1 - GROUND FLOOR UNIT - 2215 SQ.FT. LIVING, R3 OCCUPANCY, TYPE V-1HR CONSTRUCTION, 2001 CODES. **PERMIT DOES NOT INCLUDE TEMP POWER, TRASH ENCLOSURE, BLOCK WALLS AND SITE LIGHTING** BLDG. 6, LOT 26 -------------------------------------------------- Other Fees . . . . . ------------------------- . . . . DIF COMMUNITY CENTERS -RES 68.00 DIF CIVIC CENTER - RES 229.00 ENERGY REVIEW FEE 63.41 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 19.52 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Paid Credited ----------------- Due ---------- Permit Fee Total ------------------------------ 1324.57 .00 .00 1324.57 Plan Check Total 721.36 .00 .00 721.36 Other Fee Total 2083.93 .00 .00 2083.93 LQPERMIT Application Number . . . . . 05-00002652 Grand Total 4129.86 .00 .00 4129.86 LQPERMIT