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04-6269 (RPL)R P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253. Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: F04"=0� 00� 06269 " 57888'SANTA� ROSA TR 762-240-013-31 -30487 - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 22000 • �� 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 92260 II(� ntractor: Architect or Engineer: JUN 02005 18 SA VERDE LANDSCAPE MAINT COR 1 965 CENTRAL AVENUE CITY OF L�4 QUINTA C INO , CA 91710 FINANCE DEPT. ( 09)590-242.5 Lic. No.: 624647 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: 4- 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 �,y/}01,00 of the Labor Code, I shall forthwith comply with those provisions. Date: b 14W Applicant/ �f , 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 1$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. 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. /,icense CI s: C-27 License No.: 624647 Date: Contractor: AC U L 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.). " (_ 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: LQPERMIT Date: 5/25/05 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,,amd'Mr9by authorize representatives of thiis un to ter upon the above-mentioned property spe do urposes Dal?. Signature (Applicant or Agertl: 4 Application Number . . . . . 04-00006269 Permit BLDG POOL PERMIT Additional desc . Permit Fee 225.00 Plan -Check Fee 146.25 Issue Date . . . . 9/13/04 Valuation 22000 Expiration Date 3/13/05 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 . . . . 9/13/04 Valuation . . . . 0 Expiration Date 3/13/05 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 9/13/04 Valuation . . . . 0 Expiration Date 3/13/05 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 . . . . 9/13/04 Valuation 0 Expiration Date . 3/13/05 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 -7 --------------------------------------------------------------------------- Special Notes and Comments ' POOL & SPA ONLY. ALARMS'BARRIERS SHALL LQPERAIIT LQPERMIT Application Number . . . . . 04-00006269 ---------------------- ------------------------------------------------------ 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 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 . . . . 04-00006269 Date 9/10/04 Property Address . . . . . . 57888 SANTA ROSA TR APN: 762-240-013-31 -30487 - Application description . POOL - RESIDENTIAL Property Zoning . . . . . . .. LOW DENSITY RESIDENTIAL Application valuation . . . . 22000 Owner Contractor. ------------- ----------- ! i., +• *� a ---.---,— ----------- ---,- , SANTA ROSA DEV DIAMOND CREEK 40847 SANDPIPER CT 12965 CENTRAL AVENUE PALM DESERT CA 92260 CHINO CA 91710 (909) 590-2425 WCC: STATE'FUND WC: 1776208 02/10/05 CSLB: 585287 01/31/06 ---------------------------------------------------------------•------------- CCC: B1 -C53 -C27 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - A - ;- - - - ----------------- ---- ----------------- ----------- Permit Permit . . . . . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 225.00 �, Plan Check Fee ��._ 146.25 Issue Date . . . . Valuation 22000 Qty Unit Charge Per BASE FEE 20.00 9.0000 THOU BLDG 2,001-25,000 7 ------------------------------------------- Permit . . . . . . ELEC POOL PERMIT -RES Additional desc Permit Fee . . . . 45.00 Plan Issue Date . . . . Valua Qty Unit Charge Per 1.00 ' 30.0000 EA tension 45.00 180.00 BASE -FEE ELEC PRIVATE.SWIMMING POOL 11.25 0 Extension 15.00 30.00 ti i ` jW, P.O. Box 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 'Fja Date: Applicant: I Architect or Engineer: If Applicant's Mailing Address: - 77 Architect or Engineer's i6ldr s: /V//-T- 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 Code, and my License is in full force and effect. License Class IL-% CSS C-11 License No. l / ` Date �! � 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 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. , B.& 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 �At ued. orke�' compensation insurance carrier and policy number are: Carrier C Policy Number V) -7 `A6 A? 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 agre at, if I s ould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSAT OVERAGE 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 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 Ouinta, 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 co 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 t above entioned property for inspection purposes. Date + ! Signature (Applicant or Agent): 1 y. r Page 2 Application Number . . . . . 04-00006269 Date 9/10/04 Permit . . . . . PLUMBING'' Additional desc Permit Fee . . . . 33.00 Plan Check Fee 8.25 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 ONLY. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged ----------------- Paid Credited Due -7 -------- ---------- 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 _---- _ I ___ I� __ _ i