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07-1927 (RPL)P.O. BOX 1504'; 78-495 CALLE'TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: APPiiC,800rl VWUadoll: Applicant: 07-00001927 52674 PALAZO . 767-200-011-48 -318742- POOL - RESIDENTIAL - LOW DENSITY RESIDENTIAL 25000 Architect or Engineer: 0. ----------------- LICENSED CONTRACTOR'S DECLARATION BUILDING 8r SAFETY DEPARTMENT BUILDING PERMIT'' Owner: JOHNSTON RESIDENCE 52-674 PALAZO LA QUINTA, CA 92253 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 an fessionals Code, and my License is in full force and effect. License Class: B License No.: 836088 Date: 19���ntractor: 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 _ 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 1, 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 Contractor: 1ST ATRIUM INC P.O. BOX 3882 PALM DESERT, CA (760)880-6606 Lic. No.: 836088 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/03/07 92261 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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 EXEMPT Policy Number EXEMPT 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 agreethat, if I should a bj t to the workers' compensation provisions of Section 7 3700 of the Labor /6 Code, I a rthw' t comply with those provisions. Date:® %Applicant: i 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. 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 buildnA and hereby authorize representatives of this county to enter upon the above-mentioned propertlurposes. Date6J- ignature (Applicant or Agent): Application Number. . . . .. 07-00001927 -' Permit . . BLDG POOL PERMIT Additional "desc . Permit:Fee•.•.: 252.00 Plan Check Fee 163.80 Issue,.Date:.". Valuation 25000 Expiration Date 12/30/07 Qty Unit Charge Per Extension BASE•FEE 45.00 .23.00 9.0000 ------------------------------------------------------------------------------- THOU BLDG 2,001-25;000 207.00 Permit . . . MECH POOL Additional deso . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date . . . . 0 Expiration Date _Valuation 12/30/07 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 12/30/07 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 Valuation 0 Expiration Date 12/30/07 Qty Unit Charge Per. t. 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 OUTLETS3.00 Special Notes and Comments POOL, SPA, ALARMS/BARRIERS .SHALL BE IN - .LQPERMIT Bin # CI of La • City Quinta Building 8t Safety Division . P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 . ..Building Permit A licatio' and Tracking PP acking Sheet Permit.# --7 J Project Address: ` E 3 / r t,(t � S . , Owner's Name: slL A: P. Number: C Address: 2� 7 f Legal Description: dc (IC p �P S�` (�%� C Contractor: S f .{y�'� . Address: , 0• -600— 3a'�2 City, ST,.Zip. ?k-t�(,{it tit/►' G� 7�2� Telephone: 0 C) �j 606 State Lie. # Q City Lic. #: City, ST, Zip: CQ� _�y /' 22 S Telephone: - Project Description: To © 4 e— ez S' x Arch., Engr., Designer: / ,5 Address: City, ST, Zip: CWHAh I&ldid..0:/Lf._ • .' .. Telephone: State Lic. #: ,Name of Contact Person: . I/l (�t�.r s V V1 a Conch gc6on Type:. Occupancy: Project type (circle one): New "Addie Alter Repair Demo . Sq. Ft.: �# Stories: #Units: Telephone # of Contact Person: ��� . (� ©�j Estimated Value of Project: 2S 90 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING ' PERMTT FEES ' Plan Sets Plan Check submitted bot. Item Amount Structural Coles. Reviewed, ready for corrections Plan Check Deposit Truss Coles. Called Contact Person Plan Check Balance Energy Coles. Plans picked up Constructian Flood plain plan. Plans resubmitted Mechanical Grading.plan 2°" Review, ready for corrections/issue Electrical Subcontactor List ' Called Contact Person Plumbing. Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE'- ''d Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I:P.P. Pub. Wks. Appr Date of permit issue School Fees . Total Permit Fees CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS PERMIT NUMBER OWNER.'BUILDER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing -on this list or their employees are authorized to work on this job: Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. Tor each applicable trade, all .information requested below must be completed. by applicant. "On File" is not an acceptable response. .. Trade / ClassificationContractor ..:..:.......... State:Contract ot.s. License... : .....: :...:.:::. :...::..>::::::::;::>::::. ::•::...:;:.:. ; :: _ ;. :. :::::..::;>:::...: Workecs.Com erlsatton:(nsuranca . . ;'::..: ' it . Business L(cense. '.. C .y Company Name Classification License Number Exp: Date Carrier Name Poricy Number. Exp. Date . License Number Exp. Date (e.g. A,.B, C-8) (xxxxxx) (xx/xx/xx) (e.g. State_ Fund, CalComp) (Forman Varies) (xx/xx/xx) (xxxx) (xx/xxlxx) EARTHWORK 1C-121..: I� COI�ICRETE (C -8V:;-' .° ..;.. FRAMING, 5) STRU.CT::S7EEL (C -5.a1 --.p.. �+ {kk �1(�t(�t, t� /� 1..53�� 2 2 �- 33 ?30 03 0� �� l MA50NRY (C-29) PLUMBING (C-361 6 C93 %�� os h.' `Q > LATH: PLASTER:{e=' (p �, S3 S S ��0� CL ..' 53` Ooh —61 DRYWALL (C-91::..: V HVAC. ELECTRICAL. (C=10)..: S. d ��O �� : l2 C• l' Q� . ©3 �� ROOFING -J91.1 SHEET METAL (0-431 ; •FLOORING C- GLAzING (C- INSULATION-.: INSULATION:(0-2) PAINTING (C -33)' -: CERAMIC TILES (C-54)':..... .CABINETS (G-6) ... .; FENCING (0713). LANDSCAPING (C=27.);.`° POOL