05-2670 (SATT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUI �DII
✓G
Application Number: 05-00002670 C11
Property Address: 80278 VIA TESORO 0
APN: 772-250-019-16 -30357
Application description: DWELLING - SINGLE FAMILY ATTACHED
Property Zoning: LOW DENSITY RESIDENTIAL p�OG 0
Application valuation: 210345Z� rf
Applicant: _,,,_f(rchitect or Eng" eer,/
Y DEPARTMENT
PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/30/05
Owner:
TOLL CA V
O C/O KEVIN D DUERMIT
8901 E MOUNTAIN VIEW 200
SCOTTSDALE, AZ 85258
Contractor:
TOLL BROS , INC.
/ 73121 FRED WARING DRIVE, #100
PALM DESERT, CA 92260
(760)674-9699
Lic. No.: 777699
--------------------------------------------------
LICENSED /ONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am Ii ftsed under provisions o hapter 9 (commencing with
Section 7000) of Division 3 of the Business and P {essionals Code, and m icense is in full force and effect.
License la
ss: B Lice se No.: 7699
I'ate: !ti Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjuryhat 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 _) 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
1 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:
LQPERMIT
--------------- - - -
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 LIBERTY MUTUAL Policy Number WA762DO04723014
I certify that, in the performance of th ork for which this per it is issued, I shall not employ any
person in any manner so as to be ofne subject to thew S.
compensation laws of California,
nd agree that, if I should beca a ubject to the work s' ompensation provisions of Section
700 he Labor Code, I sh fo it comply wit t se provisions.
�e: [ W Applicant:
WARNING: FAILURE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITI N 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 inf rmation is correct. I a e to comply with all
city and county ordinances and state laws relating to buildi cons uction, and hereby aut ize representatives
of this c�ent��one above-mentioned grope or ins purposes.
(Applicant or Agent):
Application Number . . . . . 05-00002670
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
3.00
FLOOD ZONE
NO
PATIO SQ FTG
108.00
TOT ELIGIBLE
NO
NUMBER OF UNITS
1.00
----------------------------------------------------------------------------
2ND FLOOR SQUARE FOOTAGE
2530.00
Permit . . .
BUILDING PERMIT
Additional desc . .
Permit Fee . . . .
1028.00 Plan Check Fee
167.05
Issue Date . . . .
Valuation . . .
. 210345
Expiration Date . .
12/27/05
Qty Unit Charge
Per
Extension
BASE FEE
639.50
111.00 3.5000
----------------------------------------------------------------------------
THOU BLDG 100,001-500,000
388.50
Permit . . .
MECHANICAL
Additional desc . .
Permit Fee . . . .
90.00 Plan Check Fee
5..63
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
12/27/05
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
5.00 6.5000
EA MECH VENT FAN
32.50
1.00 6.5000
----------------------------------------------------------------------------
EA MECH EXHAUST HOOD
6.50
Permit . . .
ELEC-NEW RESIDENTIAL
Additional desc . .
Permit Fee . . . .
105.71 Plan Check Fee
6.61
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
12/27/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2530.00 .0350-
ELEC NEW RES - 1 OR 2 FAMILY
88.55
LQPERAI[T
Application Number . . . . . 05-00002670
Permit . . . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge
Per
Extension
108.00 .0200
----------------------------------------------------------------------------
ELEC GARAGE OR NON-RESIDENTIAL
2.16
Permit . . .
PLUMBING
Additional desc . .
Permit Fee . . . .
170.25 Plan Check Fee
10.64
Issuc Date . . . ,
valrnat-inn
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 7.5000
EA PLB OTHER BACKFLOW <=2 INCH
7.50
7.00 .7500
EA PLB GAS PIPE >=5
5.25
1.00 15.0000
EA PLB GAS METER
15.00
----------------------------------------------------------------------------
Special Notes and Comments
SFA - PLAN TYPE B2 - UPPER FLOOR UNIT,
2530 SF LIVING, R-3 OCCUPANCY, TYPE
V-lHR CONSTRUCTION, 2001 CODES.(GARAGE
FOR THIS UNIT LOCATED
IN PLAN TYPE A1]
**PERMIT DOES NOT INCLUDE TEMP _POWER,
TRASH ENCLOSURE, BLOCK WALLS AND SITE
LIGHTING**
REDUCED PC FEES FOR
REPITITION OF IDENTICAL PLAN TYPE.
BLDG. 3, LOT 16
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ART IN PUBLIC PLACES -RES
25.86
DIF COMMUNITY CENTERS -RES
68.00
DIF CIVIC CENTER - RES
229.00
ENERGY REVIEW FEE
16.71
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
21.03
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
. . . .
05-00002670
1393.96
.00
.00
1393.96
189.93
.00
.00
189.93
2064.60
.00
.00
2064.60
3648.49
.00
.00
3648.49