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07-2516 (RPL)P:O. BOX 1504 78-495 CALLE TAMPICO r LA QUINTA, CALIFORNIA 92253 Applicant: Architect or Engineer: rry �ll� ----------------- LICENSED CONTRACTOR'S DECLARATION 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I a licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business an Professionals Code, and my License is in full force and effect. License C ss: C8 C27 C29 4 License No.: 656128 Date: r Contractor: OWNER -BUILDER DECLARATION ' I hereby affirm under penalty of perjurythat 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 _ 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 Owner: MCCOMIC GRIFFIN LLC 7979 IVANHOE AVYF )tom LA JOLLA, CA TPP 7 Contractor: TESERRA P.O. BOX 1280 COACHELLA,.CA.9 (760)398-9222 Lic' No.: 656128 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/11/07 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 SEABRIGHT Policy Number BB1070510 _ I certify that, in the #rtemnce f e work for which this permit is issued, I shall not employ any person in any mas t be ome subject to the workers' compensation laws of California, and agree that, ie m subject to the workers' compensation provisions of Section 70y00oofthe LabII f ith comply with those provisions. Date iy Applicant:WARNING: FAILURE TO SECURENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CREN LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001. IN ADDITH COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR TER T, 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 workis 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 t4thove information is correct. I agree to comply with all city and county ordinances and state laws relating construction, and hereby authorize representatives of this co nr tyyto enter upon the above-mentioned r inspection purposes. Date: j3ld� Signature (Applic� or Agent t -_Application Number: 07-00002516 Property Address: 54720 SECRETARIAT DR APN: 767-320-999-234 -32879.- Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 30000 . Applicant: Architect or Engineer: rry �ll� ----------------- LICENSED CONTRACTOR'S DECLARATION 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I a licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business an Professionals Code, and my License is in full force and effect. License C ss: C8 C27 C29 4 License No.: 656128 Date: r Contractor: OWNER -BUILDER DECLARATION ' I hereby affirm under penalty of perjurythat 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 _ 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 Owner: MCCOMIC GRIFFIN LLC 7979 IVANHOE AVYF )tom LA JOLLA, CA TPP 7 Contractor: TESERRA P.O. BOX 1280 COACHELLA,.CA.9 (760)398-9222 Lic' No.: 656128 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/11/07 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 SEABRIGHT Policy Number BB1070510 _ I certify that, in the #rtemnce f e work for which this permit is issued, I shall not employ any person in any mas t be ome subject to the workers' compensation laws of California, and agree that, ie m subject to the workers' compensation provisions of Section 70y00oofthe LabII f ith comply with those provisions. Date iy Applicant:WARNING: FAILURE TO SECURENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CREN LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001. IN ADDITH COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR TER T, 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 workis 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 t4thove information is correct. I agree to comply with all city and county ordinances and state laws relating construction, and hereby authorize representatives of this co nr tyyto enter upon the above-mentioned r inspection purposes. Date: j3ld� Signature (Applic� or Agent Application Number 07-00002516 Permit BLDG POOL PERMIT Additional desc . Permit Fee" 284.50 Plan Check Fee 184.93 Issue Date Valuation 30000 Expiration Date 3/09/08 Qty Unit Charge Per Extension BASE FEE 252.00 5.00 6.5000 THOU BLDG 25,001-50,000 32.50 Permit . . . MECH POOL Additional desc . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date Valuation . . . . 0 Expiration Date 3/09/08 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 3/09/08 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 39.00 Plan Check Fee 9.75 Issue Date Valuation . . . 0 Expiration Date.. 3/09/08_ Qty Unit Charge Per Extension BASE FEE 15.00 3.00 6.0000 EA PLB FIXTURE 18.00 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 T LQPERMIT Application Number 07-00002516 -- -- - ----- Special Notes and Comments PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED. WATERFEATURE PER,APPROVED PLAN. Fee summary Charged Paid Credited Due Permit Fee Total 394.50 .00 .00. 394.50 Plan Check Total 212.43 .00 .00 212.43 Grand Total 606.93 .00 .00 606.93 LQPERMIT 31 Bin # Permit # Project Address:Sq--- � A. P. Number: Contractor: [ 41-E,51 RRA Address: O Box City, ST, Zip: CM Jch p m Telephone: State Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Telephone # of Contact Person: # Submittal Plan Sets Structural Cales. Truss Cales. Energy Calcs. Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN IiOUSE:- Planning Approval Pub. Wks. Appr School Fees City of La Quina Building 8L Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: lo7 Address: ° City, ST, Zip: 2-516 - I Project Description: City Lic. #: Construction Type: Occupancy: Project type (circle one): ew Add'n Alter Repair Demo �-- Sq. Ft.: #Stories: #Units: Estimated Value of Project: p APPLICANT: DO NOT WRITE BELOW THIS LINE 'd Recd TRACKING PERAM FEES Plan Check submitted 1(7 Item Amount Reviewed, ready for corrections Plan Check Deposit Called Contact Person Plan Check Balance Construction Mechanical Electrical Plumbing Plans picked up Plans resubmitted Z"° Review, ready for correctionsfissue"- Called Contact Person Plans picked up S.M.I. Grading. Developer Impact Fee A.I.p p, Plans resubmitted 7rd Review, ready for corrections/issue Called Contact Person Date of permit issue Total Permit Fees '