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04-6801 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: 04-00-0-0-6 801 57732 SANTA ROSA TR 762-240-013-26 -30487 - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 22000 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: SANTA ROSA DEV 40847 SANDPIPER CT PALM DESERT, 'CA 92260 VOICE (760).777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/25/05 1 ^00%.U11Contractor: Applicant: Architect or Engin JON 1 4 CASA VERDE LANDSCAPE MAINT COR 78341 DARBY ROAD QU1141A INDIO, CA 92203 �',FZINIAINICF DEPY• ILic. (909)590-2425 No.: 624647 --------------------------------------'----------------------------------------------------------- ' 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 and 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 Clas -27 License No.: 624647 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is /' - issued. ✓ Date: Y Contracto . \ V 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: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier GRANITE Policy Number 9549987 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, I 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 to 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 of the Contractor's State and agree that, if I should become 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 3#00 of the Labor Code, I shall forthwith 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 j ,% / L �_ �. any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: Q Applicant (_) 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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.). (_ 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.). I—) 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: LQPERAIIT 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. I certify that I have read this application and state that the above information is correct. I ie to comply with all city and county ordinances and state laws relating to building construction, and her authori a representatives of this/court to nter upon the above-mentioned grope fol 'tfscti purpo Dail: !i Signature (Applicant or Agentl ) 4 LQPERM[T Application Number . . .• 04-00006801 Permit BLDG POOL PERMIT Additional desc . Permit Fee 225.00 Plan Check Fee 146.25" Issue Date. 10/18/04 Valuation 22000 Expiration Date ., 4%17/05 Qty", Unit Charge Per Extension BASE FEE 45.00 20.00 9.0000 THOU BLDG 2,001-25,000 180.00 Permit MECH POOL Additional desc . Permit Fee 24.00 Plan Check Fee 6.00 Issue Date 10/18/04 Valuation 0 Expiration Date 4/17/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA, MECH FURNACE <=100K 9.00 ' Permit ELEC°POOL PERMIT -RES " Additional desc . Permit Fee 45.00 Plan Check Fee 11.25 Issue Date 10/18/04 Valuation . . 0 Expiration Date 4/17/05 Qty Unit Charge Pet 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 10/18/04 Valuation . . . . 0 Expiration Date • 4/17/05 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. ALARMS/BARRIERS SHALL BE IN 4 LQPERM[T Application Number . . . . . 04-00006801 ---------------------------------------------------------------------------- Special Notes and Comments PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. **PERMIT REPRINTED TO REFLECT CHANGE OF CONTRACTOR. $4.50 SUPPLEMENTAL FEE CHARGED. ---------------------------------------------------------------------------- Other Fees . . . . . . . CHANGE OF CONTRACTOR 4.50 Fee summary Charged Paid Credited Due ------------ Permit Fee Total 327.00 327.00 -------------------- .00 .00 Plan Check Total 171.75 171.75 .00 .00 Other Fee Total 4.50 .00 .00 4.50 Grand Total 503.25 498.75 .00 4.50 LQPERMIT BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICo FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number 04-0-0-006801 Date 10/18/04 Property Address . . . . . .,x=5773:2; -_SANTA ROSA TR ---------- APN: 762-240-013-26 -30487 - Application description . . . POOL - RESIDENTIAL Property Zoning . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 22000 Owner Contractor ------------------------ --------------------- SANTA ROSA DEV DIAMOND CREEK POOLS+ 40847 SANDPIPER CT 0�78341 DARBY ROAD PALM DESERT SGA 92260 IN IO CA 92203 �V�NtP (9.09) 590-2425 WCC: STATE FUND G�F�P�G WC: 1776208 02/10/05 CSLB: 585287 01/31/06 CCC: B1 -C53 -C27 ---------------------------------------------------------------------------- Permit . . . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 225.00 Plan Check Fee 146.25 Issue Date . . . . Valuation . . . 22000 Qty Unit Charge Per Extension BASE FEE 45.00 20.00 9.0000 THOU BLDG 2,001-25,000 °180.00 Permit . . . . . MECH POOL Additional desc Permit Fee 24.00 Plan Check Fee 6.00 Issue Date . . . . 'Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 -----------------------------------------------------=---------------------- Permit . . . . . . ELEC POOL PERMIT -RES Additional desc°. Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date Valuation 0 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 P.O. BOX 1504• '��� • w VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 TOt INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 64-0801 Date: •O Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS 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 C de, and License in Jorce and ecense ffect. � ense Class ss CI se No.` / / Date /AO X&AVY n—Gctor hl O 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 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 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 maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is TT i Sued. workers' compensation mance carrier nd olicy num §r are: �rrier SlA\ w.� �licy Number �i 2ci �f I certify that, in the Wormance of the work for which this peimit 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 th I ould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CQ 1.2i�AGE 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.). Lenders Name 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, indemnity 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. I certify that I have read this application and state that the above information is correct. I a ree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon th a -men ' ned property for inspection purposes. ate�� r;Sc ignature (Applicant or Agent): Page 2 Application Number . . . . . 04-00006801 Date 10/18/04 Issue Date . . . . Valuation 0 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. ALARMS/BARRIERS SHALL BE.IN. -PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED. Fee summary Charged 'Paid Credited Due Permit Fee Total 327.00 .00 .00 327.00 Plan Check Total 171.75 .00 .00 171.75 Grand Total 498.75 •.00 .00 498.75