04-4027 (RER)j
BUILDING & SAFETY DEPARTMENT
— ° - P.O. BOX 1504
(760).777-7012
D OFTt'9 78-495 CALLE TAMPICO FAX (760) 777-7011
MAY 1 4 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
CITV.0F LAQUItITA . BUILDING PERMIT..
FINANCE DEPT.
Application Number 04-00.60402-7--
Date 5/11/04
Property'Address 80436 SPANISH"BAY
APN:. 775-320-013-32 -28960 -
Application description'. REMODEL -.RESIDENTIAL
Property -Zoning LOW DENSITY RESIDENTIAL..
Application .valuation 500
Owner Contractor
CENTEX HOMES SUNLITE DEVELOPMENT, INC.'
2280 WARDLOW. CIR STE 150 P.O. BOX ""10668
CORONA. CA.92880 PALM DESERT
CA 92255
(760), 340-9800
WCC: EXEMPT.
WC: EXEMPT
05/07/05
CSLB: 655874
10/31/04
CCC: B""
Otherstruct "info. . " CODE:::EDITION
2001 "
-Permit .. . . . ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . " 1.5'. 75': Plan Check Fee
3'. 94
.Issue Date" ... ...Valuation
0
.Expiration Date 5/11/05
Qty Unit Charge Per :-
)Extension
BASE' FEE'
15.00
1:00. .7500 PER ELEC DEVICE/FIXTURE 1ST 20
.75
Permit . . . PLUMBING.
Additional desc ".
..Permit Fee 18:00 :Plan Check.Fee
.". 4.50
Issue Date .. Valuation....
0
Expiration Date 5/11/05
Qty Unit Charge Per
Extension
BASE FEE
,1,5.00
1.00 3..0000, EA PLB WATER INET/ALT/REP
3.00
Special Notes .and Comments
. MOVINO GAS AND ELECTRICAL 10' FOR BBQ.
Fee summary "Charged Paid. Credited.
Due.
I
"v
P.O. BOX 1504 • � •
w VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or
Lic. No.:
BUILDING PERMIT DECLARATIONS
Add
LICENSED CONTRACTOR'S DECLARATION
1 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 Uce?5is in full force and effect. ���
License Class rr License No. y
Data Contractor_ uni L(' 4 Qp V e-
� .K�Nr r}•/i1e.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 Uoense 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 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.).
U 1 am exempt under Sec. , B.& P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of pejury one of the following declarations:
.—I have and will maintain a certificate of consent to self4nsure 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 pemmlt is
is�cied,,,,,,���AAAy workers' compensation insurance cornier a lic number AM•
carrier Q 1 t ry�p a wow Number s`'
_ I certify L in the rho nce of the work for which this perm is ued. I shall not employ any parson 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
forthwith comply with those provisions.
Date Applicant
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
1 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 iequest 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 harnless 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 100 days from date'of issuance of such permit, or
cessation of work for 160 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 here/by authorize representatives of this county to entSr upon the above-mentioned property for Inspection purposes.
Date 1 /�"'/ Signature (Applicant or Agent):
Page . 2
Application Number
04-00004027
Date 5/1.1/04.
Permit ;Fee Total-'
33.75 .. 00,
.00
33.75
Plan Check Total
8.44 .00
.00
8.44
Grand Total
42.19 .00
.0.0.
.42". 19