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05-2650 (SATT)S. - O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: cr c&`�/ °FXWQ" & SAFETY DEPARTMENT ILDING PERMIT 05-00002650 // 80286 VIA TESORO (/ 772-250-019-6 -30357 DWELLING - SINGLE FAMILY ATTA ED LOW DENSITY RESIDENTIAL C/ 235565 �j�!_ O?.7, CFWW, ✓ D Architect or Engineer: '�T r �-Je 4rGIC -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am 'tensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business an rofessionals Code, an my License is in full force and effect. License Class B License No/ 777699 rM,Bate: � or: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perj that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Busi 'ss 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 (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, 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 _ 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: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/29/05 Owner: TOLL CA V C/O KEVIN D DUERMIT 8901 E MOUNTAIN VIEW 200 SCOTTSDALE, AZ 85258 Contractor: TOLL BROS, INC. 73121 FRED WARING DRIVE, 4100 PALM DESERT, CA 92260 (760)674-9699 Lic. No.: 777699 ------------------ 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 i issued, I shall not employ any person in any manner so as tolborneescubienthto the workers' ompensation laws of California, and agree that, if I should becsut e workers' c pensation provisions of Section 3 O Labor Code with co ply with tho rovisions. ate: vm plicant: �� WARNING: FAILURE TO SECURE W 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 ADDIT 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 wor or 180 days will subject permit to cancellation. I certify that 1 have read this application and state that the aboverformation is corre agree to comply with all city and county ordinances and state laws relating to building co struction, and hereb thorize representatives of this cou ty t ante Pon t eabove-mentioned propert r ' ion pu ate: �� gnature (Applicant or Agent): Application Number . . . . . 05-00002650 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 503.00 PATIO SQ FTG 173.00 TOT ELIGIDLD ern NUMBER OF UNITS 1.00 ---------------------------------------------------------------------------- 2ND FLOOR SQUARE FOOTAGE 2694.00 Permit . . . BUILDING.PERMIT Additional desc . Permit Fee . . . . 1115.50 Plan Check Fee 725.08 Issue Date . . . . Valuation . . . . 235565 Expiration Date . . 12/26/05 Qty Unit Charge Per Extension BASE FEE 639.50 136.00 3.5000 ---------------------------------------------------------------------------- THOU BLDG 100,001-500,000 476.00 Permit MECHANICAL Additional desc . Permit Fee . . . . 90.00 Plan Check Fee 22.50 Issue Date . . . . Valuation 0 Expiration Date . . 12/26/05 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 . . . . 122.81 Plan Check Fee 30.70 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/26/05 Qty Unit Charge Per Extension BASE FEE 15.00 LQPERMIT Application Number . . . . . 05-00002650 Permit . . . . . . ELEC-NEW RESIDENTIAL Qty Unit Charge Per Extension 2694.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 94.29 676.00 .0200 ----------------------------------------------------------------------------- ELEC GARAGE OR NON-RESIDENTIAL 13.52 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 183.00 Plan Check Fee 45.75 Issue Date . . . . Valuation 0 Expiration Date . . 12/26/05 Qty Unit Charge Per Extension BASE FEE 15.00 19.00 6.0000 EA PLB FIXTURE 114.00 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 8.00 .7500 EA PLB GAS PIPE >=5 6.00 1.00 15.0000 EA PLB GAS METER 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFA - PLAN TYPE C2 - UPPER FLOOR UNIT - 2694 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** BLDG. 1, LOT 6 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 88.91 DIF COMMUNITY CENTERS -RES 68.00 DIF CIVIC CENTER - RES 229.00 ENERGY REVIEW FEE 72.51 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 23.55 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Paid Credited Due --------------------------- Permit Fee Total ------------------------------ 1511.31 .00 .00 1511.31 Plan Check Total 824.03 .00 .00 824.03 Other Fee Total 2185.97 .00 .00 2185.97 LQPERMIT Application Number . . . . . 05-00002650 Grand Total 4521.31 .00 .00 4521.31 LQPERMIT