05-2674 (SATT)116il.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Proper ly ZUI Iiny.
Application valuation:
Applicant:
0/
T4'lvl °F 4 Q"
_05-00002674 I
80279 VIA TESORO BLD 4 C -1L
772-250-019-23 -30357 -
DWELLING - SINGLE FAMILY ATT
LOW DENCITY RECIDENTIAL
199102
/ Architect or Engineer:
BUILDING,& SAFETY DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am I; nsed under provisi of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and P ofessionats Code, my License is in full force and effect.
License Class: , B License L-97-7'699
/bate: /J�ntractor
NG PERMIT
Owner:
TOLL CA V
✓�j 0 C/O KEVIN D DUERMIT
`( 8901 E MOUNTAIN VIEW 200
O,� 1 TTSDALE, AZ 85258
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjur 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$5001.:
1 _ 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.).
1 _ 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
l _ I 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: a
Lender's Address:
LQPERPIJT
L,ontractor:
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:
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.
L 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 MI"IJAL Policy Number WA762DO04723014
I certify that, in the performance olAhe work for which this permit is issued, 1 shall not employ any
person in any manner so as to ecome subject to the rkers
' compensation laws of California,
and agree that, if I should be me subject to the wor rs' compensation provisions of Section
700 f the Labor Code I al o hwith omply w se provisions.
crate:? (/ x/scant:
WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI INAL 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 become null and void if work is not commenced
within 180 days from date of issuance of such permi 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 information is correct. agree to comply with all
city and co my o inances a ate laws relating to building An ruction, and hereby thorize representatives
of this co (y to niter n the above-mentioned property f cti - our e
Dale: ignature (Applicant or Agent):
Application Number . . . . . 05-00002674
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 532.00
DATM qQ FTr, 132..00
TOT ELIGIBLE NO
NUMBER OF UNITS 1.00
1ST FLOOR SQUARE FOOTAGE 2252.00
----------------------------------------------------------------------------
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 919.50 Plan Check Fee 149.42
Issue Date . . . . Valuation . . . . 179781
Expiration Date . . 12/27/05
Qty Unit Charge Per Extension
BASE FEE 639.50
80.00 3.5000 THOU BLDG 100,001-500,000 280.00
----------------------------------------------------------------------------
Permit . .
Additional desc .
Permit Fee . . .
Issue Date .
Expiration Date .
MECHANICAL
65.50 Plan Check Fee . . 4.10
Valuation . . . . 0
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
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 . .
. .
107.10
Plan Check Fee
6.70
Issue Date . .
. .
Valuation . . .
. 0
Expiration Date
. .
12/27/05
Qty Unit
Charge
Per
Extension
BASE
FEE
15.00
LQPERMIT
Application Number . . . . . 05-00002674
Permit . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge
Per
Extension
2252.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
78.82
664.00 .0200
----------------------------------------------------------------------------
ELEC GARAGE OR NON-RESIDENTIAL
13.28
Permit . . .
PLUMBING
Additional desc . .
Pormit Fee 1
178.90 Plan Check Fee
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 C1 -
GROUND FLOOR UNIT -
2252 SQ.FT. 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
REPITITION OF IDENTICAL PLAN TYPE.
BLDG. 4, LOT 23
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . DIF COMMUNITY CENTERS -RES
68.00
DIF CIVIC CENTER - RES
229.00
ENERGY REVIEW FEE
14.94
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
19.91
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
. . . .
05-00002674
1270.60
.00
.00
1270.60
171.38
.00
.00
171.38
2035.85
.00
.00
2035.85
3477.83
.00
.00
3477.83