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05-1865 (RPL),, P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN:' Application description Property Zoning: Application valuation: Applicant: c 05-000018657 48084 BIG HORN DR 658-140-999-18 -29436 POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 19000 Architect or I BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, an is ns ' in full force and effect. License Class: c� License Date:s k)y of Contract OWNER -BUILDER DECLAR ION ].hereby affirm under penalty of perjury that I am exempt from the Contract tate 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 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 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: LQPER.NIIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/23/05 Owner: STOLLE, JR. GARRETT 48-084 BIG HORN LA QUINTA, CA 92253 Contractor: CROCODILE CONSTRUCTION WCC: STATE FUND WC: 1795231 09/01/05 CSLB: 840210 06/30/06 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. have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor i Code, for the performance of the work for which this permi is iss ed. Myrs' compe orlon ir, ��� insur nc carrier nd policy number are: (� - - - O k arrier=-i---/ Policy Numbery0�r ��� I ce ify tha , in thd 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 370he Labor Code s all forthwith comply w'th 'sions. te:.� Applicant: WARNING: FAILURE TO SECURE WORK ' COMPENSATION COVERAGE IS U W , 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 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 work for 180 days will subject permit to cancellation. 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating 5�st ruction, and hereby authorize r presentatives of this county to enter upon the above-mentioned petiondte:r� Sig ature (Applicant or Agent Application Number . . . , 05-00001865 Permit . . . BLDG POOL PERMIT Additional desc . Permit Fee . . . . 198.00 Plan Check Fee 128.70 Issue Date . . . . Valuation . . . . 19000 Expiration Date 11/12/05 Qty Unit Charge. Per Extension BASE FEE 45.00 17.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 153.00 Permit . . . MECH POOL Additional desc . . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation 0 Expiration Date 11/12/05 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 11/12/05 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 . . 11/12/05 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 LQPERMIT Application Number . . . . . 05-00001865 ---------------------------------------------------------------------------- Special Notes and Comments BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary ------------- Charged Paid - --- ---------- --------=- Credited ---------- Due Permit Fee Total 302.00 .00 ---------- .00 302.00 Plan Check Total 154.70 .00 .00 154.70 Grand Total 456.70 .00 .00 456.70 LQPERMIT CITY OF .LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS d PERMIT NUMBEROWNER �5 ToLL BUILDER This form shall e paste on the I the Building ILispectlonall . 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 bV applicant. "On File" is not an acceptable response. Trade / Classification CortoeGtcr :......, . Sbtte. Goritractbr's•Liceriae :' ;> ' ; r .. n c.:.,... ;. " ?' :: " ' Wglrrlts;i3o e){xat)orl Ipsuranclf:":�`;:':> `•::.' Cit' Buslnba 'L1Cgnee Company Name Classification license Number Exp. Date le.g. A. B, C•91 lXxxXxxl (xxlxxlxx) Carrier Name (e.g. State Fund, CaiComp) Policy Number (Format Varies) Exp. Date lxxlxxlxx.) License Number ixxxxl Exp. Date lxxlxxlxxl EARTHWORK(C-121 15 - 767 3Un,CO4 :• 1113 CIA, ' 2 cc I J _0 4 q-1- C tSTRUCT,-FVEE � 11 ov • (or 0_ -D(( -os' PLUMBING (C-361• � - l7 1-v (4 9-1. -vs q'?S tl-3��-f ELECTMCAL (C-101 .' �QJI i (? Sk 1715231 ROOFING (C•38):: •; .. . CERAMLC;111 E( _ b.4) •:"j .per- / o G s `,� SCJ C'R�J 1 %3 .� 7� �y —2 - o� S'r G �"� � ©� -©l ��i �� 3 REVISIONS BY L {1 w 4 wk r Y� D a Ti 7 WQ 0 F � � o DRAWN K.RADONI CHECKED & L. DATE -❑6-05 SCALE 1 IBM =1 '-0"' JOB NO SHEET S-1