05-2757 (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:
C05-00002757
.54075 SOUTHERN HILLS'
775-101_-038- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
25000
Architect or Engineer:
o A
BUILDING & SAFETY -DEPARTMENT
BUILDING PERMIT
10
L_ JUS 2o
f. LA
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Owner:
t HOESMAN BRUCE JON/SUZANN
54-075 SOUTHERN HILLS'
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760).777-7153
Date: 7/06/05
1
Contractor:
BRYAN.INVESTMENTS GROUP, INC.
WCC: GRANITE STATE
WC: 1518726 03/29/06
CSLB: 552140 06/30/06
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LICENSED CONTRACTOR'S DECLARATION 1,WORKER'S
COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division.3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: - - License No.:
for by. Section 3700 of the Labor Code, for the performance of the work for which this permit is
_ 0 y/�-
•�
C�
Y/- issued. - -
C�
Date: W Contractor: Q cl /
Jl 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
' OWNER -BUILDER DECLARATION - `
insurance carrier and policy number are: �. .
` I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier B C53, Policy Number - - - - - - - - - - - - - - -
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to -
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in* any manner so as to become subject to the workers' compensation laws of California, -
permit to file a signed statement that he or she is licensed pursuantto the provisions of the Contractor's State -
- and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Co I shall forthwith comply with the provisions.
that he or she is exempt therefrom and thebasis 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).:
•Date: G(Jpplicant: .
(_ I I, as,owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnot intended or offered for sale (Sec. 7044, BusinessandProfessions Code: The
WARNING: FAILURE TO SECURE 0 KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIM L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through hisorher own employees, that the -
.'.DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
- -' improvements are not intended or offered for sale. If, however, the building or improvement is sold within
. SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. '
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.). '
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for'a permit subject to the
s^� - 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
t property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors'.State License Law.). -
- whose benefit work is performed under or pursuant to any permit issued as a result of this application, _
(_ 1 I am exempt under Sec. , B.&P.C. for this reason -
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.
• * Date: Owner:
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,1 80 days will subject
- . • - _ -- - - CONSTRUCTION LENDING AGENCY
permit to cancellation.
_ - I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all -
' work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinancesandstate laws relating to building construction, and hereby authorize representatives
..
of this county to enter upon the above-mentioned prop y for inspection purposes.
' Lender's Name:
• -
'
1%gnature
• ,� Lender's Address:-
D .0 (Applicant or Agen
LQPERAtiT
-
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` Application Number 05-00002757
Permit . . ...BLDG -POOL PERMIT
_ Additional-,desc .
Permit Fee . . 252.00 Plan Check Fee
163.80
Issue Date Valuation
25000
Expiration Date 1/02/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
23.00 9.0000 THOU BLDG'21001-25`,000
207.00
Permit . . . MECH POOL
Additional desc .
Permit Fee 26.00 Plan Check Fee
6.50
Issue Date . . . . Valuation . . . .
0
Expiration Date 1/02/06
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 1/02/06
Qty Unit Charge Per
,-Extension
BASE FEE
15.001-
1.00 30.0000 EA i 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 1/02/Q6
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
003_
3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00'
_ --
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Special Notes -and Comments
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
LQPERMIT
_