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05-4809 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA; CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation:. Applicant: C05-000Z-1 5.778eTROON WY 762-360--007- POOL RESIDENTIAL LOW DENSITY RESIDENTIAL 33000 Architect or Engineer ----------------- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/27/05 Owner: SOUTHERN HILLS.DEVELOPM ENT 55161 SOUTHERN HILLS LA QUINTA, CA 92253 Contractor: OV®� TOPMAN BUILDERS O 4 2005 WCC: CLARENDON WC: 01KR-0030-842 03/23/06 V.0(FLj�jAylMw CSLB: 455121 06/30/06 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 a d Pr ssiona C de, and my License is in full force and effect. License Class: is se No.: r Date: 1'�' O Contractor: ✓ O ER -BUILDER DECLARATION I.hereby affirm under penalty of perjury th I am axe pt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business an fe ns 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 herselfthroughhis 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 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 _ 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 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 B C29 C53 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 come subject to the workers' compensation laws of California, and agree that, if I should be ome ubje to the workers' compensation provisions of Section 3700 of the Labor Code, I sh II fo wiiomply with those provisions. ate:,1` Applicant:, WARNING: FAILURE TO SECLIFIE WORKERS' CPMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CFkIMINAL PENAL ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADD( N TO THE COVT OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CO 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 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 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 ab mforma ' n is rrect. I agree to comply with all city and county ordinances and state laws relating to bu'Idi construction, n he by authorize representatives of this county to enter upon the above-mentioned p erty r inspection rp es date:`� •��Signature (Applicant or Agent): Application Number 05-00004809 Permit . . . BLDG POOL PERMIT Additional desc Permit Fee. 304.00 Plan Check Fee 197:60 Issue. Date' Valuation - 33000 Expiration Date:. 4/25/06 Qty Unit Charge,.,Per Extension BASE'FEE 252.00' 8.00 6,.5000 THOU BLDG 25,001-,50;'000 52.00 Permit MECH POOL Additional desc - Permit. Fee .. 26 ..0.0 Plan .Check • Fee '. - = - -: Issue Date Valuation 0 _ Expiration Date 4/25/06_ - 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 4/25/06 Qty Unit".Charge,. Per• `,Extension. „ 4, 1.0.0 30.0.000 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 ... 4/25/06 „ Qty `Unit Charge Per 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 T-4 OUTLETS 3.00. . Special'Not'and Comments POOL & SPA ONLY:_ ALARMS/BARRIERS SHALL LQPERMIT - - - - - - r Bin # City of La Quinta Building & Safety Division P.O. Box. 1504, 78-495 Calle Tampico La Quinta, CA 92253— (760) 777-7012 Building Permit Application and Tracking Sheet Permit # T / Project Address: ?S� f floes Owner's Name:�—S . t J A. P. Number: Address: Legal Description: City, ST, Zip: L/A Qv t CA 22S Contractor:�1�-f2AA 12�Q Telephone: M z � , Address: tjuta o J Project Description: City, ST, Zip: QV 2Z I k Telephone: �!�- rt :N City Lic. #: State Lic. # : Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: az r Name of Contact Person: h Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: WO - —7' �,9 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING.. PERMIT FEES Plan Sets Plan Check submitted 2� Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Cates. Plans picked up Construction 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:- '"' 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