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05-1705 (RPL)t , P.O. BOX 1504 it VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 TY 4 4 a INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: %O Date: Applicant: Applicant's Mailing Address: D/! 7"e A C To ye Architect or Engineer: Architect or Engineer's Address: Lic. No.: N;>!q BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed u er p visions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals ode, and my Lice is i orce and effect. cense Class —J _S Li ns ✓ Date ` [ d S ^ Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U 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 or 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.). U 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.). U I am exempt under Sec. , BA P.C. for this reason Date WORKERS' 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. I have and will maint workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is i d y work compensation insurance carne IM �j L6' y,qy� e �arrier Policy Number AMf —I certify that, in the performance of the work f this permit is issued, I shall no employ any person in any manner so as to become subject to the workers' compensation laws of California, and agr a hat, if should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall c/ forthwith comply with those pr is ns. D32�y[ �! d✓ Applicant/ ✓WARNING: FAILURE TO SECURE WORK S' CO TION 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. 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 114 l Lender's Address 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 wo ging performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void' wo 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 info ation is e I ag ee to comply with all city and county ordinances and state laws relating to building const ion, and hereby authorize representatives of this count t e er upon t e abo a entioned property for inspection purposes. Date VIAS__ ✓/% / Signature (Applicant or Agent): v ----------------------=----------------------------------------------------- Application Number . . . 05-00001705 --------------=-----------------------------------=------------------------- Permit . . . . . . Additional desc Permit Fee Issue Date Expiration Date BLDG POOL PERMIT 117.00 • 10/31/05 , Plan Check Fee . . 76.05 Valuation . . . . 9728 Qty Unit Charge Per Extension BASE FEE 45.00 8.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 72.00 Permit . . . . . . MECH POOL Additional desc Permit Fee . . . . .26.00 Plan Check Fee 6.50 Issue Date Valuation 0 Expiration Date 10/31/05 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 10/31/05 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 10./31/05 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 Permit . . . Additional desc . . Permit Fee . . . . Issue Date Expiration Date WALL/FENCE PERMIT 15.00 10/31/05 Plan Check Fee . . .00 Valuation . . . . 272 Qty Unit Charge Per Extension BASE FEE 15.00 ----------------------------------------=----------------------------------- Special Notes and Comments SPA ONLY. 17 L.F. 4' BLOCK WALL, CITY STANDARD. ALARMS/BARRIERS SHALL BE IN.• PLACE PRIOR TO PRE -PLASTER INSPECTION.' ---------------------------------------------------------------------------- Application Number . . . . . 05-00001705 ---------------------------------------------------------- Special Notes and Comments EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged Paid Credited Due Permit Fee Total 230.00 00 .00 '230.00 Plan Check Total 100.55 .00 .00 100.55 Grand Total 330.55 .00 .00 330.5.5 City Of La Quints Building &r Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address• ' _ 11 �� �� Owner's Name: S' _ A. P. Number: l — i Q Address: Legal Description: City, ST, Zip: Contractor. COIL ©D1.5 Telephone Address: C)Box n0 Project Description: City, ST, Zip:66066 14 Cl 19 3 (0 O� Telephone: — 9 Called Contact Person Plan Check Balance •}.'.. Rk;R•.vv:•'.•:'.';ir.i<};\'..k:. r.: r:;:?::c$:i State Lie. # City Lie. #: Arch., Engr., Designer: Flood plain plan Address: Plans resubmitted 7� ! f. I t � 0,1� Vl L. �I/ ✓�' �� Mechanical Grading plan . City, ST, Zip: 2" Review, ready for corrections/issue Telephone: _ }rr�:iryv?i:.....t•liJ•{.%l{•}•�4C•{;:{xvyKi?�:;}:i tij•$•}4 «;�;;::��;s��v�.>�f<.,..xr•�.;:rus�;� Construction Type: Occupancy: }� l•�•� Ak L: State Lie. #: ...r.'.•fr•r••}Fr}.:.:r.:i:}:•::,r..�.,.:mo:.{,:f.'.�':.:..:y`.r�.r:.ti..2.;., .}u.'.4. Proj ect hPa circle one). NAdd'n Alter Repair Demo Name of Contact Person: DAN S46;15 -w- Sq. FL: # Stories: # —units:- Telephone # of Contact Person:.2 ? s-, / ;Vi YJ Estimated Value of Project: jgo j APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal ' Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted 2�25/Z Item Amount Structural Calcs. Reviewed, ready for corrections Plan. Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan . 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L. H.O.A. Approval Plans resubmitted Grading IN HOUSE: ''" Review, ready for correctionslissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees '9;L- oo 0