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05-1950 (RPL)-,P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92.253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: 0505 00001950- 51225 AVENIDA RUBIO 7737044-029- - POOL - RESIDENTIAL MEDIUM DENSITY RES 25.000 �ot uza.. BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or ab LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with / Section 7000) of Division 3 of the Business and Professionals Code, and4ny License is in full force and effect. License Class: icense Ned// te: Contract 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 ($500).: (_ 1 1, 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 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.). 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 ISec. 3097, Civ. C.). Lender's Name: - Lender's Address: LQPERMTT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/20/05 Owner: POH, CHARLES 51-225 AVENIDA RUBIO LA QUINTA, CA 92253 Contractor: DEBONIS & FAUBION CONSTRUCTION WCC: EXEMPT WC: EXEMPT 09/30/05 CSLB: 737479 06/30/05 WORKER'S COMPENSATION DECLARATION 1 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: anter B, C39 Policy Nu 'bar _ 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 become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 s ly with those provisions. aeCe: Applic WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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 employeesfor 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 above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives 7thi'ounty to enter upon the above-mentioned propertyrinspection purposes. Signature (Applicant or Agent): Application Number . . . . . 05-00001950 Permit . . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 252:00 Plan Check Fee 163.80 Issue Date . . . . Valuation 25000 Expiration Date _ 11/16/05 Qty. Unit Charge Per Extension BASE FEE 45.00 23.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,00.1-25,000 207.00 Permit . . . MECH POOL Additional desc . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date .11/16/05 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 11/16/05 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 . . . . 27.00 Plan Check Fee 6.75 Issue Date Valuation. 0 Expiration Date 11/16/05 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 ---------------------------------------------------------------------------- Special Notes and Comments POOL WITH HEATER ONLY. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT LQPERMIT Application Number . . . . . 05-00001950. - Special Notes and Comments ---- - INCLUDED IN PERMIT.` Fee summary Charged ' Paid Credited Due Permit Fee Total 350.00 .00 .00 350.00 Plan Check Total" 188.30 .00 .00 188.30 - Grand Total 538.30. .00 .00 538.30 - LQPERMrr CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS V -0Q S PERMIT NUMBER OWNER BUILDER 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 tocommencement of work. Failure to comply will result in a stoppage .of work and/or the voidance B I� '53) � I K �� KX/G f�LR�'� � C • � s3 30 U6� 13!7 5POOLlC I SW 3a4 I Z•2B I I I