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05-2666 (SATT)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: rroperty toning: Application valuation: Applicant: 05-00002666 80275 VIA TESORO 772-250-019-21 -30357 - DWELLING - SINGLE FAMILY LOW DENSITY RESIDENTIAL 195908 Ti4t °F 4Qu&w & SAFETY DEPARTMENT %—Architect or Engineer: LICENSED CDNTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am lic sed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pr essionals Code, and y License is in full force and effect. License C "71Vsss: License No.: 77699 ,Bate: Y' ontrac[or. / OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjuryhat I am exempt from the Contractor's State License Law for the following reason ISec. 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 solecompensation, 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.). (_ 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: Q Lender's Address: �" ' LQPERA11T IT Owner: TOLL CA V C/O KEVIN D DUERMIT 8901 E MOUNTAIN VIEW 200 SCOTTSDALE, AL 05250 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: 6/30/05 ----------------------------------------------- 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. 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 of I certify that, -in the performance a work for which this ermit is issued, I shall not employ any person in any manner so as to come subject to the ers' compensation laws of California, and agree that, if I should bec me subject to the wor r 'compensation provisions of Section 737 0 of . e Labor Code s II hwith coTRply w' hose provisions. icant: WARNING: FAILURE TO SECURE W& KERS' 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 nf6rmation is correct. agree to comply with all city and co my ordi ances and state laws relating to building c struction, and hereby thorize representatives of this cow tt yy ttto/JPS er upo a above-mentioned property or ns a pur Date: !/v nature (Applicant or Agent): i ,11,11,11b" LQPERniIT Application Number . . . . . 05-00002666 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 450.00 PATIO GQ PTO 1110.00 TOT ELIGIBLE NO NUMBER OF UNITS 1.00 1ST FLOOR SQUARE FOOTAGE 2233.00 ---------------------------------------------------------------------------- Permit . . Additional desc . Permit Fee Issue Date . . . Expiration Date . BUILDING PERMIT 975.50 12/27/05 Plan Check Fee . . 158.52 Valuation . . . . 195908 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 . . . . 72.00 Plan Check Fee 4.10 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/27/05 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 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 ELEC-NEW RESIDENTIAL 104.96 12/27/05 Per BASE FEE Plan Check Fee . . 6.56 Valuation . . . . 0 Extension 15.00 Application Number . . . . . 05-00002666 Permit . . . . . . ELEC-NEW RESIDENTIAL Qty Unit Charge Per Extension 2233.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 78.16 590.00 .0200 ---------------------------------------------------------------------------- ELEC GARAGE OR NON-RESIDENTIAL 11.80 Permit . . . PLUMBING Additional desc . . Permit Fee . . . . 178.50 Plan Check Fec 11.16 Issue Date . . . . Valuation 0 Expiration Date . . 12/27/05 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 B1 - GROUND FLOOR UNIT, 2233 SF 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. 4, LOT 21 ---------------------------------------------------------------------------- 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 19.59 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged --------------------------- Paid Credited ------------------------------ Due LQPERMIT Application Number Permit Fee Total 1330.96 Plan Check Total 180.34 Other Fee Total 2036.44 Grand Total 3547.74 LQPERMIT 05-00002666 00 .00 1330.96 00 .00 180.34 00 .00 2036.44 00 .00 3547.74