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07-2603 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/26/07 Application Number:" 07-00002603 Owner: Property Address: 81805 RUSTIC CANYON. DR SIGLER RESIDENCE APN: 764-280-999-45 -300237- 81-805 RUSTIC CANYON DR. Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: MEDIUM HIGH DENSITY RES Application valuation: 15000 Contractor:" OCT j Applicant: Architect or Engineer: TESERRA P.O. BOX 1280 tc9l�.dp;. COACHELLA,' CA 92236 (760) 398-9222 d.. Lic. No.: 656128 ------------------------------------------------------------------------------------------------- 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: Section 7000) of Division 3 of the Business a Professionals Code, and my License 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: C8 C27 C29 License No.: 656128 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is _ issued. _Date:/ Contractor.— z _ 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 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 Carrier SEA 3RIGHT Policy Number , BB1070510 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as t become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions oftheContractor's State and agree that, if I should bec a subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 700 of the Labor C I sh II rthwith comply with those provisions. 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).: { Date: [ Applicant: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and - ( J . .. - the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO -SECURE WO PENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES 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 CODE, INTEREST, 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.). APPLICANT ACKNOWLEDGEMENT 1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with -a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1 _ I. I am exempt under Sec. B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City 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: LQPERi1IIT 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 within180 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 i formation is correct. I agree to comply with all city and county ordinances and state laws relating to buitdin cons uction, and hereby authorize representatives of this gounp/ tq enter upon the above-mentioned property f�r insp tion purposes. Date: or Agent): Application Number ... . . . 07-00002603 Permit BLDG POOL PERMIT Additional desc'. Permit Fee . . . 162.00 Plan Check Fee 105.30 Issue Date Valuation 14680 Expiration Date 3/24/08 Qty Unit Charge Per Extension BASE FEE 45.00 13,.,00 9:0000 ---------------------------------------------------------------------------- THOU BLDG 2; 001-25, 000 1.1.7.00' Permit . . . MECH POOL Additional desc . Permit Fee. . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation 0 Expiration Date 3/24/08 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 3/24/08 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 . . . 27.00 Plan Check Fee 6.75 Issue Date . . . Valuation . . . . 0 Expiration Date 3/24/08 Qty Unit Charge Per Extension BASE FEE 15.00. 1.00 6.0000 EA . PLB FIXTURE 6.00 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. Permit WALL/FENCE PERMIT .LQPERMIT - . ' Application Number . . . . . 07-00002603 Permit WALL/FENCE PERMIT Additional desc . Permit Fee, 15.00 Plan Check Fee .00 Issue•Date . . Valuation 320 Expiration Date 3/24/08 Qty Unit Charge Per Extension BASE FEE 15.00 ------------ ------------ ------------------------------------------------ Special Notes'arid,comment� , SPA, ALARMS/BARRIERS SHALL BE JN PLACE AT PRE -PLASTER INSPECTION. 48" X 20' L.F. CITY STANDARD EQUIPMENT WALL. Fee summary Charged Paid' Credited Due Permit Fee Total 275.00 .00 .00 275.00 Plan Check Total 129.80 .00 .00 129.80 Grand Total. 404.80 .00• .00 404..80 " LQPERMIT Bin # Permit # 94V/ Project Address: % _ g 5 A. P. Number: ! Legal Description: Contractor: 7; L� Address: City, ST, Zip: �� H Telephone: M-27,7,2— State Lie. # Arch., Engr., Designer: Address: City, ST, Zip: Telephone:, State Lie. #: Name of Contact Person: e Telephone # of Contact Person # Submittal Req'd Plan Sets Structural Calcs. Truss Cates. Energy Calcs. Flood plain plan Grading.plan Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees City of La Quoin Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet N M1 Owner's Name: G � Address: City, ST, Zip: Project Description: ___[ �ZZ 3 IV, Lie. #: M Total Permit Fees Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo 2-- Sq. Ft.: #-Stories: # Units: ® Estimated Value of Project i APPLICANT: DO NOT WRITE BELOW THIS LINE Recd TRACKING . PERMIT FEES Plan Check submitted Item Amount Reviewed, ready for corrections Plan Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted Mechanical 2nd Review, ready for correctionsrissue Electrical Called Contact Person Plumbing Plans picked up S.M.I. Plans resubmitted Grading. I'd Review, ready for corrections/issue Developer Impact Fee Called Contact Person A.I.P.P. Date of permit issue Total Permit Fees �� ,;, x "�� � �� �I '� �s ':