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05-2651 (RPL)`t 440 P.O. BOX 1504 �VOICE 760 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 6/29/05 Application Number: 05-00002651 Owner: Property Address: 45325 CARRIE LN MILLER RANDAL C APN: 604-375-001-1 -2789.9 - 45-325 CARRIE LANE Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 12000 D Contractor: Applicant: Architect or Engineer. JUN 3 0 2005 MCRAE POOL & SPAS WCC: EXEMPT WDA C�OFjIp,(lUINTA WC: EXEMPT 09/30/05 Cil Q2 /� /4 FINANCEDEPT. CSLB: 823'01.7 08/31/05 ------------------ 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, and my License is imfull force'and'effect. License Class: License No.: Date:: A�Contractor:, 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 theyrovisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7600) of._Division 8 of thoeusiness 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.applicantto a civil penalty of not more than five. hundred,dollars ($500).: (_ 1 I, as -owner of'the property,or my employees with'wages as their sole compensation, will do the work, and the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License, Law does not apply to an owner of property who builds:or improves thereon, and who does the work'himself orherself through his or her own employees, Provided that the improvements are•not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build,or improve.for the purpose of sale.). 1—) 1, as owner of the property, am exclusively contracting with licensedcontractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State'License Law does not apply to an owner of ,prop erty'who builds or Improves thereon, and contractor(s). who contracts for the projects. with a contractor(s) licensed pursuant to the:Contractors' State.License Law.). . I—) I am exempt under Sec. , B.$P.C. for this reason 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: L.QPE V41T WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintains certificate of consent to self4nsure 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„forthe performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier C53 Policy. Number - - - - - - - - - -- - - -- _ I.certify.that, in the performance of the.work.forwhich this.perrtiit 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, iwthe workers' compensation provisions of Section 3700 of the Labor Code, l shall rthwith comply with those r visions. I�plicant, 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 370e 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 conditionsend 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�s result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify -and hokRharmless the City of La Quints, 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 isnot commenced within 180 days from date of'issuanse,of such permit, or cessation of work for 180 days will subject permitto cancellation. I certify that'1 have read this.application and state that the above information is correct. I agree to comply with all cityand county ordinances and staie'laws relating to building construction, and hereby authorize representatives of this unty to enter upon the above-mentioned pro for inspection purposes. D Signature (Applicant or Ager Application.Number . . . . . 05-000.02651 Permit BLDG POOL PERMIT_ Additional desc . . Permit Fee . . . 135.00 Plan Check Fee 87.75 Issue Date . . . Valuation . . . . 12000 Expiration Date . . 12/26/05 Qty Unit Charge Per Extension BASE FEE 45.00 10.00 9.0000 .THOU BLDG 2,001-25,000 90.00 PermitMECH POOL Additional desc . Permit Fee . . . . 26._00 Plan Check Fee 6.50 Issue Date . . Valuation . . . . 0 Expiration Date . . 12/26/05 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 12/26/05 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 12/26/05 Qty Unit Charge Per Extension BASE. FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.0.0 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 ONLY.•ALARMS/BARRIERS SHALL BE IN 'J LQPERMIT Application Number . . . . . 05-00002651 ------------------------------------------ ---------------- ---- Special Notes and Comments PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged Paid Credited Due -- - - --------- - - - - ----- -- -- Permit 'Fee Total 233.00 .00 .00 233.00 Plan Check Total 112.25 .00 .00 '112.25 Grand Total 345.25 .00 .00 345.25 L,QPE"tff CITY OF LA QUINTA SUR -CONTRACTOR 11.9 JOB ADDRESS; PERMIT NUMBER OS --.26S/ OWNER _ - BUILDER_ Mcg POOH This form shall be posted on the job with the B ilding Inspection Card ;fit all times in a conspicuous place. Only persons appearing on this list or their employees are authorizeWto 4vork on this job. Any changes to this list must be approved by the Building Division prior to commencement of work.Fail to com�lywil s4ltt in a stoppage of work and/or the v ance of building permit. For each applicable trade, all information requested below must be completed by applicant.: "On File" is not an acceptable respzonse. eq'V C -- 0-5 4 Trade_/ Classification Contractor State Contractor's License "11Vorkers�� C m ensation Insurance City Business License Company NameTClassification. , B, C-8) License Number Ixxxxxxl Exp.]- (xx/x Carrier Name (e.g. State Fund, C.alComp) Policy Number (FormatVaries) Exp. Date (xx/xx/xx) License Number, (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) C CAV O 2'I O G O SI CONCRETE (C-8) C �/ ©.ZIO FRAMING (C-5) STRUCT. STEEL (C-51 /� E W ) Jnr MASONRY (C-29) n �7' 3 y -� 0� - 1� w/ 1-Ub PLUMBING (C-36) - W �G //` LATH, PLASTER (C-35 c --s3 -9 o/0 -S-07- s�i - 5-1-09 iz-Ind DRYWALL (C-9) - - HVAC (C-20) ELECTRICAL(C-10) E —ag2iwg _ S 2 f / •3 h ROOFING (C-39) - SHEET METAL (C-43) FLOORING (C-15) GLAZING IC -17). INSULATION (C-2) SEWAGE DISP. (6-42) 4 PAINTING (C-33) CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) LANDSCAPING (C-27) POOL IC -53) . A S D,S q7-218 _ 6. - - 3 ;� .S-.. iTo- _0 0 o 0 CITY OF LA QUINTA SUILDI JG & SAFETY DEPT. A RROVE® FO CONSTRUCTION p RE-INSPEC gE CHARG ON FEE 0 D IF THE AFF $30 ROVED WILL PLANS AND joi iCAASCH�E I O� O� THE SITE FOR l 1NSPECTINo CEPTIONS! 6' Hous 5 -- q.5-3aS,CARQi5 LAI LA Q u NT'q c A P001scapes & Designs 760-772-2440' Lie S. 828017 mr" "T 3 l 6' 3� mr" "T 3