05-1805 (RPL)P.O. BOX 1504
78-495 GALLE TAMPICO
LA QUINTA, CALIFORNIA 922h
Application Number: 05-0000180-57-1
Property Address: 5024�--ViA AMANTE
APN: 772 -390 -034 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 15000
A -tyl T 4
BUILDING & SAFETY DEPARTMENT
BU.ILDING PERMIT - -
t4h, 16 2005
Applicant: Architect or EngjneA—d�-
OF: �U�PIQS'UJ 1"T4
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I �ereby aff'irm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Xs�iondf the Business and Professional� Code, and gpy Lip in ful�Noa effect.
License Class: License No.e"
�,6a'te: T -/b Contractor: .77e
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 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, 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 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.).
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.)_
I am exempt under Sec. B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury t hat there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.I.
Lender's Name:
Lender's Address:
LQPER1111T
Owner:
R J T HOMES
1425 E UNIVERSITY DR
PHOENIX, AZ 85034
Contractor:
RjT HOMES LLC
STATE FUND
WC: 1583906
CSLB:. 690645
VOICE (760) 777-7012.
. FAX (760) 777-7011
INSPECTIONS (760) 777-7153
10/01/05
06/30/06
Date: 5/11/05
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - —
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
i sued.
lhave 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
, d Ii y number are:
Carrier A-13 .9"FirlynZ151c Policy Number 4 '37AL3_9A
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 forthwith comply with those provisions.
Maf�e: �`/9-101�'Applicant.'� --r"S
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.
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 pomply with all
city and county ordinances and state laws relatin' ildini ru authorize representatives
-d y
of this county to enter upon the above-mentione 5pro� rcionnsstec
Da - 7 Tignature (Applicant or Age
125�
LQPERMIT
Application Number . . . . . 05-.00001805
Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Fee 162.00 Plan Check
Fee..
105.30
Issue Date . . . . Valuation
15000
Expiration Date 11/07/05
Qty Unit Charge Per
Extension
BASE FEE
45.00
13.00 9.0000 THOU BLDG 2,001-25,000
---------- 7 -----------------------------------------------------------------
117.00
Permit . . . . . . MECH POOL
Additional desc
Fee . . . . 26.00 �Plan Check
Fee
6.50
-Permit
Issue Date Valuation
. . .
. '0
Expiration Date 11/07/05
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 11.0000 EA MECH FURNACE >100K
------------------------------------------------------------------------
11.00
7
Permit ELEC POOL PERMIT -RES
Additional desc
Permit Fee. 45.00 Plan Check
Fee
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 11/07/05
�Qty Unit,Charge Per
Extension
BASE FEE
15.00
1.00 30.0000 EA EtEC PRIVATE SWIMMING
----------------------------------------------------------------------------
POOL
30.100
Permit PLUM13ING
Additional.desc
Permit Fee 33.-00 Plan Check
Fee
8.25.
Issue Date Valuation
0
Expiration Date 11/07/05
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 1-4 OUTLETS
3.00
- --- - - - - - - - - - - - - - - - - - 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Special Notes and Comment s
- - - - - - -
- - - - - - - - - - - - - -
POOL & SPA ONLY. GAS/ELEC. DRAIN STUB
OUT FOR -FUTURE BBQ (BY SEPARATE
PERMIT). ALARMS/BARRIERS SHALL E IN
PLACE PRIOR TO PRE -PLASTER INSPECTION.
EQUIPMENT -ENCLOSURE NOT INCLUDED IN
LQPERMIT
Application Number
. . . . .
05-00001805
- - -------------------------------------------------------------------------------
Special Notes and
Comments
PERMIT.
Fee summary
-----------------
Charged
----------
Paid
----------
Credited
---------- ----------
Due
Permit Fee Total
266.00
.00
.00
266.00
Plan Check Total
131.30
.00
.00
131.30
Grand Total
397.30
.00
.00
397.30
LQPERA11T
W"V
Morro
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