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RPL (05-2236)79859 Memorial Pl 05-2236 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Applican' CON 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner- FERNANDEZ ALICIA P 79-859 MEMORIAL PLACE LA QUINTA, CA 92253 --------------------------------- Contractor: or Engineer: Owner Date: 6/09/05 -----------------------=--"__d-------------------------------- ----------------------------------=--- LICENSED CONTRACTOR'S DECLARATION Application Number: 05,700002236 Property Address: 79859 MEMORIAL PL APN: 604-501-020-11 -24197 - Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation_: 20000 Applican' CON 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner- FERNANDEZ ALICIA P 79-859 MEMORIAL PLACE LA QUINTA, CA 92253 --------------------------------- Contractor: or Engineer: Owner Date: 6/09/05 -----------------------=--"__d-------------------------------- ----------------------------------=--- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:' ectise 70001 of Division 3 of the Business and Professionals Code, and m icense is in full force and effect. _ I have and 'will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: license No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is te: Contractor: issued. _KI 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 OWNER -BUILDER DECLARATION - insurance carrier and policy number are: hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the j,,Carrier Policy Number- Jollowing reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to ! _I_cenify that, in the performance of the work for which this permit is is , I IF, ot employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the V . person in any manner so as c e sub'ect to the ork rs' pen on laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I sho ec c tot a ork pens n pr ' ' s of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 ofthe Labor de, I wi comply wi se pro on - 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).: _ . Applica (_ 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 WARNING: FAILURE TO SECURE WORKERS' COM NSATI N COVERAGE IS UN WF , AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER 70 CRIMINAL PENAL SAND VIL FINES UP TO ON HU RED THOUSAND ' - and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,0001. IN ADDITION TO Ll ST OF OMPENSATION, DAM AS PROVIDED FOR IN ` ' improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR C EREST, AND ATTORNEY'S FEES. 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; a5 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 the nrod who contracts for the pth a contractors) licensed pursuant to the Contractors' St f icens Law.. 1 _ 1 I am exempt under Sec. _ , B.&P.0 t .reaso CONST CT N LENDING AGEffV I hereby affirm under penalty of perjury that there is con ruction lending a for the performance of the work for which this permit is issued (Sec. 3097 w. C - Lender's Name: Lender's Address: LQPERAIIT APPLICANT ACKNOWLEDGEM T IMPORTANT Application is hereby made to the Director of Building and Safe(yy 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 no ced - within 180 days from date of issuance of such permit, or cessation of work for 180 days will s ' t permit to cancellation. certify that I have read this application and state that the ab mfor tion is correct. I agree to i all city and county ordinances and state laws relating to buil g con5truc ereby utho ' pr nt ves of this county, to enter uApwthe above-mentioned pro for ' pe p poses. ' Application Number . . . . . 05-00002236 Permit . . . BLDG POOL PERMIT Additional desc . �';'• Permit Fee 207.00 Plan Check Fee -. 134.55 Issue.Date . . . . Valuation . . 20000 Expiration Date 12/06/05 Qty Unit Charge Per Extension BASE FEE 45.00 18.00 9.0000 THOU BLDG 2,001-25,000 ---------------------------------------------------------------------------- 162.00 Permit . . . ,MECH POOL Additional desc . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . 0 Expiration Date 12/06/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 11.0000 EA MECH FURNACE >100K 11.00 Permit ELEC POOL PERMIT -RES Additional desc . Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date Valuation 0 Expiration Date 12/06/05 Qty Unit Charge, Per Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 Permit PLUMBING Additional desc Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation 0 Expiration Date 12/06/05 Qty Unit Charge Per - Extension BASE FEE 15.00 2.00 6.0000 EA PLB FIXTURE 12.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 .1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 Special Notes and Comments POOL & SPA ONLY. ALARMS/BARRIERS SHALL LQPERMTT Application Number . . ,05-00002236 -----------------------------------------------------_------------ Special Notes and Comments BE.IN PLACE"PRIOR TO PRE -PLASTER e;• ' INSPECTION. EQUIPMENT ENCLOSURE NOT ( INCLUDED IN PERMIT. Fee summary Charged Paid Credited Due Permit Fee Total 311.00 .00 .00 311.00 Plan Check Total 160.55 '.00 .00` 160.55 Grand Total 471.55 .00 .00 471.55 LQPEINIIT OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder -of the property improvements specified. For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and. the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and, Federal Government as an employer and you are subject to several obligations include State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.. If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board- in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 923 m I PROPERTY PERMIT NU ER(S) CITY OF LA QUINTA SUB-CONTRACT013-LIST AL JOB ADDRESS PERMIT NUMBER OWNER 741 t C.MD ....BUILDER 0w K3 P2 1 _> This form shall be posted on the Job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant.. -un rile" is not an acceptable response. Trade /Classification Contractor State Contractor's License'- '' : Workers.Compensation: Asuran City Business License Company Name Classification (e.g. B, C-8) License Number (xxxxxx) Exp. Date (x x/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp: Date (xx`/xx//xx) License Number Exp. Date (xx/xxj/xx) EARTHWORK(C12) l`] i \ F . Y Arr, 1 ?0 3550 /3t 6 5 flJ // // 7W'c > 3 Go L//tl0 r (xxxrx)) CONCRETE LC1t ► `2ulCTl Z 3 O ! 31,3110q \ ►l Z J 3 a Ali G ` :r$, C 1(p-OQI S30Co FRAMING IC 5) STRUCT STEEL (G-51); ' EM lzq l C, DU J U / t " l ( iP f t / i I (p 'i 0 j S JO p ) i I t 1 Q (p ry ['D 71 ( ler 11 a0 MASONRY (C:.29. L UMBING (C 36)' }!•v ` } L 1c3 (E, ` :r$, C 1(p-OQI S30Co LtIi 1()e b171 rJ LATH. PLASTER (C 35) DRYWALL (C7:9h:.>:';;::. . .20::-:;( ELECTRICAL IC 101 ` +" , !•J 3SS f =f lb( ?' 61 6 .1 / ( 06% a d( a P / 7 GLAZING'(C.:l.7. : ...:: N'CERAMIC TILE (C 54) 1 . C fir) t `CVL C-[l I n 9 Z3 b 1301 I0 1 I J *' i C TU N 12z6o q IP/os a 7 ' ?-o 4 I C , C -S-:5 1'70931 I-7/3116toI SF,Q Z_-) 01/6 ~661 U016 y I l l. ,06 1 '%e 2 9/6 !