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05-1062 (RPL)BUILDING &.'SAFET•Y DEPARTMENT ,Box 1504... . (760).777-.7012 95 CALLE TAMPICO , FAX (760) 777-7:011 )UINTA, CALIFORNIA 9.2253 -.INSPECTION REQUESTS (760) 7-77-7153 .BUILDING PERMIT" Ation Number 05 `.0'0001062 + -Date P� operty Address . . . . ... 78620 SANI.-TA,DR APN: 604-;174 014 .179 .-232.69 - Application descriptibn'POOL_;w RESIDENTIAL Property Zoning .. . . . . LO,W- DENSITY `RESIDENTIAL. Application valuati"on 25,0'00,' 3'/25/05 Owner Contractor POST JUSTIN OWNER ,-L, i� CA -" 9 . 4-A (Pu I NTS --------------- ---------------- - - - - ---- - ----- - --" - ------------------- Permit BLDG POOL PERMIT Additional desc Permit.. Fee .252.. 00 -Plana Check Fee 16.3: 80 Issue Date . . . Validation 25000 Qty Unit Charge Perate Extension " BASE FEE .; .. '« 45.00 23.00 9.0000 THOU BLDG 2,0,01-25,0.00 207.00. Permit . . . MECH POOL Additional desc ,. Permit Fee . . . . 24.'00 Plan Cheek Fee 6.00 Issue Date Valuat`lon . . :;. 0 Qty Unit Charge Per Extension BASE)FEE . '� �, ' �,., ' .; ,, a `'- 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 Val'uat,on 0 Qty Unit Charge Per Extension BASE FEE ., 1 1.5. 00 1.00 30.0000 EA •'ELEC PRIVATE: SW,-IMMING, -POOL .30.00 Permit PLUMBING Additional desc . Permit Fee 33.00 Plan,Che.ck.Fee. 8.25 Issue Date . . . . ,Val, ation 0' Qty Unit Charge . Per', 'Extension BASE. FEE 15.00 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: 0J- / 0 Date: 3• oZS"Dc� Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS A4A 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 License No. Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law fair 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 ariy applicant fora 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.). as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' G� 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 2s�as caner < y / 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 issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number 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 3700 of the Labor Code, I shall 3' forthwith comply with those provisions. /Plate Q✓Aoolicant 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 ($100,000), 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 _ A2 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 the above-mentioned property for inspection purposes. urate. !� Signature (Applicant or Agent): Page 2 Application Number . . . 05-00001062 Date 3/25/05 Qty Unit Charge Per Extension 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 PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged Permit Fee Total 354.00 Plan Check Total 189.30 Grand Total 543.30 Paid Credited Due .00 .00 354.00 .00 .00 189.30 ..00 .00 543.30 11 I o 10.52 wil 5.5° 3 }} CITY OF..LA QUINTA=SUB CONTRAC O,� T LI �•cJ 51. L . °� BUILDER c� JOB ADDRESS -Aa' 4_ . l"• PERMIT NUMBER. OWNER�J — This form shall be posted onAhe job with the Booldi ` An pectiort Card at all times iri a conspicuous piace. Only persons appearing on this list or their employees are authorized to.work This on this job. Any ch_ ahges mstoppage to this list must be approved by the Building Division prior. to commencement of work. Failure to comply will result in a sof work and/or the voidance L of building permit. For each a licable trade, all information requested: below. must. be;completed\py a plicant. °On.'F..ile" is -.not an •acceptable: response. a assn �et►on J f Gontrac for :.:................. ................. .::::.:: St afs &Gtor � tf�p5 :.>:. ... i#15vr .........:..: �:::_:.,...,.: of 8 5 G altt�atsoii YV >� f e ....:.:..............;� ....:: } ..:.::.........:.:.......... ...... ::: ~: ~':..............:: Com an Name' P y ClassiRcatlon . Llcense:Number Exp. Qete :k Gamier -Name ,..Policy Number "Exp: D. `License Number (xxxx) r 6xp'. Date (xx7icx/xx)- H . ; (e.g. A. B. C -S) (xxzxxxj i; x(xx/xx/xxl' : (e.,q state Fund: CaiGompi (Format Varies) T (xx/xx/xx) . , ; .. AttTHW+Qft i~� �l2I -s 61 Dtio.S' NO + 1. ` 3l 'R1iA�iC�1 � - r LttNIB)11C. G 6 Lv' - Y u :: �n 8 a �o o !3.� 7.1 1 laRllliltAtt (C $) 0 o mF�- a'OL4 53► ��i�r lc; .�3 b . nJ � o� �le.� a r 3 Cf�$ G4 • 6;n i., OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/Builder" you :are. the responsible party of record on such a permit. Building permits are not required to be signed byprop'erty:bwners unless they:&.pe.rsonallyperforming their own work. If your work is' being performed by someone other than.youfself .you may protect yourself from possible liability if that person applies for the proper permit in his, or her name. Contractors are required by law to be licensed and bonded by the_ State of; California and- to. have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various. trades that -you plan to subcontract, you should be aware of the following information for your benefit and. protection: If you employ or otherwise engage any persons other .than your immediate family,'and the work (including materials and other costs) is $200.00 or more for the entire project, and, such persons are' not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you _must register with the'State and Federal:Government as an` employer and you are subject to several obligations include State and Federal income tax withholding;:fed'eral social;.securitywwxes, .worker's compensation insurance, disability insurance costs and unemployment: compensation cgntributions,_. There may be financial risks for you if you do not carry out these,obligdtions, and these -risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact,the Internal. Revenue Service (and, if you wish, the U.S. Small Business Administration).'For'nore specific' 'information about your obligations under State Law, contact the Department of Benefit- Payments and the Division of Industrial.Accidents. If the structure is intended for sale, property owners who are not licensed :contracts are allowed to perform their work personally or through their own employees; without a licensed contractor or subcontractor, only under'limited conditions. A frequent practice of unlicensed persons professing to be contractors: is- to' -secure an. !'Owner/Builder" building permit, erroneously implying that the ;property owrier .is providing his or. her 'own Gabor and-jmaterial ,personally. Building permits are not required to be signed by property owners unless. they are performing,_their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' :State License Board in your community or at 1020 N. Street, Sacramento, California. 95814. Please complete and return the enelosed .owner -builder verification form so that we.can confirm that,you are -aware of these matters. The building•permit will not be issued until the.verification-is returned. Very. truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX: (760) 777-7011 �- 311 C S O R'S SIQ(NATURE/DATIf 7-f-42-0 S 4 04, Dr. ZOOJo:�Ai PROPERTY ADDRESS PERMIT NUMBER(S) a 92- Zs'2;'