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05-3693 (SOTB)P.O.'BOX 1504 ����� VOICE 760 777-7012 ( ) 78-495 CALLS TAMPICO _ FAX (760) 777.7011 , LA QUINTA, CALIFORNIA 92253 - BUILDING & SAFETY DEPARTMENT • INSPECTIONS (760) 777-7153 -BUILDING PERMIT - IL P T - - , - .r Date: 8/19/05 Application Number: 05=000.03693- - Owner: £ Property Address: 5407.5 SOUTHERN .HILLS HOESMAN BRUCE JON/SUZANN APN: _ ' 775-101-038- - _ 54075 SOUTHERN HILLS D' Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA, CA 92253. �. Property Zoning:.' "LOW DENSITY •RESIDENTIAL s Application valuation: , 1000 Contractor: 3 Applicant: Architect'or Engineer: BRYAN INVESTMENTS GROUP, INC. Cin,o©Us 3_ 301ADGER STREET, #.200 LDE h • (760)345-8483 � ;P7 �. - �K Lic . No.: 552140 • LICENSED CONTRACTOR'S -DECLARATION - WORKER'S COMPENSATION DECLARATION .S I hereby affirm under penalty of per' r 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 siness d 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 LicenWCIB - LicenseNo.• 140 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued: Date:ntract r: w �` - - - _ y - Ihave 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: 71ury 1 hereby affirm under penalty of pthat I am exempt from the Contractor's State License Law for the Carrier GRANITE STATE - Policy -Number 1518726 following reason (Sec. 7031.5, Business and Professions Code:.Any city or county that requires a permit to - MEMPLOYERT at, in the pe ance 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 - in any map er so s to become subject to the workers' compensation laws of California, permit.to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State. •ee that, 'f I shout become subject to the orke ' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or * f .the bor Cod , I shall forthwith com y ' h t se provisions. - . t'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).: e:1 nt: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 WARNINO SECU WORKERS'COMPENSATION OVERAGE IS UNLAWFUL, AND-SHALLContractors' State License Law does not apply to an owner of .property who builds or improves thereon, SUBJECER T RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided. that the : . DOLLARS ($100,000). IWADDITION 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 1, 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 ..7044, Business and Professions Code: The Contractors' State License Law doesnotapply town owner of conditions and restrictions set forth on this application. 1 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 underor 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 ermit, or cessation of work for 180 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 st that the ab a information is correct. I agree to comply with.all _ work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws rel ing to buildin construction, and hereby ize representatives - • of this-cou ty to enter upon thea ove-menti ned property r inspection purposes ���•- - Lender's Name: - - D ent):''- Lender's Address: LQPERMIT _ - LQPERMIT ' e Application Number 05-00003693 Permit . . . ELEC-MISCELLANEOUS Additional'desc Permit Fee 22:50 Plan Check Feer. .00 Issue Date- Valuation 0 ' Expiration Date 2/15/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 7.5000 EA ELEC PWR APP >1 TO <=10 7.50 ----------------------------------------------------------------------------- Special Notes and Comments WATER FEATURE PER APPROVED PLANS Fee summary Charged Paid Credited Due Permit Fee Total 22.50 .00 .00 22.50, Plan'Check Total `.00 00 .00 00. Grand"Total 22.50 .00 .00 -.22.50= LQPERMIT '