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05-2671 (SATT)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Td4t 4 4a Q" Application Number: _05-00002671 J Property Address: 80277 VIA TESORO a/Jf APN: 772-250-019-22 -30357 - 6r! Application description: DWELLING - SINGLE FAMILY AT CHED `+Rdloi Property Lonlriq' LOW DENSITY RCEIDENTIAL Application valuation: 210345�C Applicant: Architect or Engineer - f2 & SAFETY DEPARTMENT tILDING PERMIT Owner: TOLL CA V C/O KEVIN D DUERMIT 8901 E MOUNTAIN SCOTTSDALLE,AZVIEW 200 85258 g -------------------------------------------------- LICE SED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 m licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business nd Professionals Co • e, and my License is in full force and effect. License C hssss: Lice a No.: 777699 /te: !/t/ontractor: 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 1$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 (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.). (_) 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 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: 0 i P( LQPERMIT Contractor: TOLL BROS, INC. 73121 FRED WARING DRIVE, 4100 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. 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 the work for which this permit is issued, I shall not employ any person in any manner so as to b ome subject tot workers' compensation laws of California, and agree t that, if I should bec a subject to the rker :compensation provisions of Section 7�3 00 he L r Code, s 1 hwith co ith those provisions. /VY��/ 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 1$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 abov i formation is corre . I agree to comply with all city and county ordinances and state laws relating to building on truction, and here uthorize representatives of this c�tqrentth bove-mentioned grope r i ion rose DatQ: pplicant or Agent): LQPERMIT Application Number . . . . . 05-00002671 Permit . Additional desc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . Qty Unit Charge 2530.00 .0350 ELEC-NEW RESIDENTIAL 105.71 Plan Check Fee . Valuation . . . . 12/27/05 Per BASE FEE ELEC NEW RES - 1 OR 2 FAMILY 6.61 0 Extension 15.00 88.55 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 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 . Additional desc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . Qty Unit Charge 2530.00 .0350 ELEC-NEW RESIDENTIAL 105.71 Plan Check Fee . Valuation . . . . 12/27/05 Per BASE FEE ELEC NEW RES - 1 OR 2 FAMILY 6.61 0 Extension 15.00 88.55 LQPERMIT Application Number . . . 05-00002671 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 Iceus 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 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 REPETITION OF IDENTICAL PLAN TYPE. BLDG.4, LOT 22 --------------7------------------------------------------------------------- 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 Application Number . . . . . Permit Fee Total 1393.96 Plan Check Total 189.93 Other Fee Total 2064.60 Grand Total 3648.49 LQPERMIT 05-00002671 00 .00 w 1393.96 00 .00 189.93 00 .00 2064.60 00 .00 3648.49