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04-7418 (RPL)IV P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 00.4-0.006_7418 Property Address: 57851 SANTA ROSA TR APN: 762-240-013-5 -30487 - Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 22000 4�VOICE 760 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Owner: SANTA ROSA DEV 40847 SANDPIPER CT PALM DESERT, CA 92.260 r 1 Contractor: Applicant: Architect or En U� .0 1 005 CASA VERDE LANDSCAPE MAINT COR 78341, DARBY ROAD OF 1� IDEp INDIO, CA 92203 (909) 590-2425 Lic. No.: 624647 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 in full force and effect. LicennsseClass: C-27 1 UcenseNo.: 624647 . a: C� Contracts V(_ 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 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 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 (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT Date: 5/25/05 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. 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: Carrier GRANITE Policy Number 9549987 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 r/ 00 of the Labor Code, I shall forthwith comply with those provisions. Date: T Applicare? rC/ <L V L 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 ($100,0001. 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. I 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 to building construction, a�_epresentatives of this u//n///�`qqq'''�% to nter upon the above-mentioned pro/pe/ray for inspection pur Date: $' &&5 Signature (Applicant or AgentlY Application Number . . . 04-00007418 Permit . . BLDG POOL PERMIT Additional desc . Permit Fee . . . . 225.00 Plan Check Fee 146.25 Issue Date . . 11/23/04 Valuation . . . . 22000 Expiration Date 5/23/05 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 . . . . 11/23/.04 Valuation 0 Expiration Date 5/23/05 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 . . . . 11/23/04 Valuation . . : . 0 Expiration Date 5/23/05 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 . . . . 11/23/04 Valuation 0 Expiration Date 5/23/05 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 & SPAS. ALARMS/BARRIERS SHALL LQPERMIT Application Number . . . . . 04-00007418 ---------------------------------------------------------------------------- Special Notes and Comments BE IN PLACE PRIOR TO PREPLASTER 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 0 LQPERDtIT P.O. Box 1504 78-495 CALLE .TAMPICO LA QUINTA,' CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).'777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application,Number . . . . . 04-00*007418 Date 11/23/04 Property Address . . . . . . 57851 SANTA ROSA TR APN: 762-24*0=013-5 -30487 - Application description . . . POOL - RESIDENTIAL. Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation_22000 Owner Contractor,,,', SANTA ROSA DEV DIAMOND CREEK POOLS 40847 SANDPIPER CT 78341 DARBY ROAD PALM DESERT CA 92260 INDIO CA 92203- 2203(909) (909)590-2425 WCC: STATE FUND. WC: 1776208 02/10/05 CSLB: 585287 01/31/06 CCC: Bl -C53 -C27 Permit MECH POOL Additional desc Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation 0 Expiration Date 11/23/05 Qty Unit Charge Per Extension 1.00 9.0000 -----------------------------------------------7---------------------------- BASE FEE. EA MECH "FU•RNAOE <=100K -''"'' 15.00 `"`` 9.00 Permit . . . . . BLDG POOL PERMIT Additional desc Permit Fee 225.00, P1= ;;—_Che= —Fee "°, 146.25 Issue Date . . . . 'V.a .'u) tion' 0 22000 Expiration Date 11/23/05 Qty Unit Charge Per Extension BASE FEE 45.00 20.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25, 000 dg�F�� 180.00 Permit . . . . . . ELEC POOL PERMIT -RES Additional desc Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 11/23/05 Qty Unit Charge Per Extension BASE FEE - _ 15.00 1.00 30.0000 EA-.. -`�� EI;E�C ;PRIVATE_"SWIMMING POOL `��'` "3,0. 00 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: b 7 Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Lic. No.: BUILDING PERMIT DECLARATIONS VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 7.77-7153 Date: 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 i in full force and effect.( License Class _—.S_ License No. Dateill L Contractor_ fjy%d A � �Q Q � V6 a OWNER -BUILDER DECLARATION 1 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 Owner 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 ss d. My worker ' compensation insurance carrier and policy number are: Carrierll, Policy Number 1 7) Cage _ 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 th should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall �1 forthwith comply with those provisions. Date Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSAT 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 Lenders Name Lenders 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 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 agree 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 o -mentioned property for inspection purposes. �� Ut Date Signature (Applicant or Agent): Page 2 Application Number . . . . . 04-00007418 Date 11/23/04 Permit . . . . . . PLUMBING Additional,desc Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/23/05 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..0.000 -------------------------------------------------------------------------------- EA PLB GAS PIPE 1.-4 OUTLETS 3.00 Special Notes and Comments POOL & SPAS. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged Paid Credited Due Permit F&e Total 327.0.0 .00 .00 327.00 Plan Check Total 171.75 .00 .00 171.75 Grand Total 498.7.5 .00 .00 498.75 - _ - ----- __ ! --------- --__ _ �_ __� 1_- �- 1 __ - -1 _ - _ _ __ -�-�� - - -- - - - ---_ -- 1 �. ,,..r. ,... -r---- - �