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04-5733 (RPL)J , 6 BUILDING & SAFETY DEPARTMENT P.O. Box 1504 y,. (760).777-7012 78-495 C.ALLE TAMPICO FAX (760) 777=7011 LA •QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT `' f Application Number Property Address . . APN: Application description.. Property Zoning . . . . Application valuation . . -" 04 -`Q_Q0,0573_3 --- .. -533-6-3-AVENIbA- VELASC 774-084-017-6 -000 POOL - RESIDENTIAL COVE RESIDENTIAL. 11000 Owner Contractor LUNA ANGEL OWNER 53363 AVENIDA VELASCO LA QUINTA CA 92253 27/04 AUG i 9 1004 Iry f OF O► uo.. _ I 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 <=1001( 9.00 ---------------- Permit ------------------------------------------------------------ BLDG POOL PERMIT Additional desc Permit Fee' 126.00 Plan Check Fee 81.90 •Issue Date . . . . Valuation 11000 Qty Unit Charge Per Extension BASE FEE 45.00 9.00 9.0000 THOU BLDG 2,0.01-25,`000 81.00 Permit ELEC'POOL PERMIT -_RES Additional desc Permit Fee . . . . 45.00 Plan Check Fee'. 11..25 Issue Date Valuation 0 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 . . . . 27.00 Plan Check Fee 6.75 P.O. BOX 1504 • 444" VOICE (760) 777-7012 7f3-495 CALLS O FAX (760) 777-7011 LA QUINTA, CALIFORNIAFOR 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: ()Zf - 5733 Applicant: Applicant's Mailing Address: 07 Date: Architect or Engineer: Architect or Engineer's Address: 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 License No. 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 applicant to a civil penalty of not more than five hundred dollars ($500).): 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. , BA P.C. for this reason Date g— 0-01V 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 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 b forthwith comply with those provisions. S Date ' n—ioy 1"�pplicant WARNING: FAILURE TO SECURE WORK RS' 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 Lenders 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, 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 Date g^ 17-0 / Signature (Applicant or Agent): r Page 2 Application Number . . 04-00005733 Date 7/27/04 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 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 -------------=-------------------------------------------------=------------ Speci'al Notes and Comments POOL 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 222.00 .00 .00 ---------- 222.00 Plan Check Total 105.90 .00 .00 105.90. Grand Total 327.90 .00 .00 327.90 a'1 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 by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, 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 planrto 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 including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, 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 Adminstration). For more 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 contractors 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 owner is providing his or her own labor and material 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 enclosed 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 1�44&tnal R'S SIGNATURE/DATE �3- 3 6:3 AyF_ UrInS«' PROPERTY ADDRESS PERMIT NUMBER(s) tet. F � CITYOFLA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS 5.3 -363 Avg. JEJAsco PERMIT NUMBER OWNER A )GE/ LUNE BUILDER eOW{ye=. 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. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. :...:. e....Class�f�cat�on...................................... Trad { »;.<:>::>:::<::::::::;:::;::::: C tractor ..::::.::.:::::::::.:.::.... on <.::::::;::>:<:<::>:::>::>:> n e State..C. nt ractor..s.L�ce s q ::::::::::::::.>::>::>::::>::::::;:>::::;::::.: ::>:<:::>::;::.:::><>::::<::::::. ...........W.otkecs..Com n a �on::lnsuranc ;::::;:::.>:::.::.;:.:> >:.;::.:;:.;:<•;:.;.:.;. .est e.. p.............................................................................. ..:::.:. Cit Bus ss.. Y................................................ ens ......... . Classifica ion L is nse Number Exp. Date Carrier Name Policy Y Number ExP Date nse Number Licensee Exp.. 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