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04-7523 (RPL)dy, BUILDING & SAFETY DEPARTMENT . f, 1. . P Q. ,BoX :15.04 (760) 777-7:012 C� OP._ 78-4.9`5 CALLE TAMPICO •FAX (760) 777-701.1 LA .i `bI14TA, CALIF0"RN'iA •92253 PECTION, REQUESTS (.760) 777-7153 BUILDING` PERMIT Application Number.r--0`4-00007523t 12/01/04 Property Address •:, 43708 PARKWAY-- ESPLANADE_W: :. ,. APN: -6.09N2590�=026 - Application 'description .,-POOL. = RESIDENT.IAL Property Zoning ."LOW.DENSITY RESIDENTIAL Application valuation 200"0.0' Owner Contractor BRANDON.FERNANDEZ OWNER 43708 PARKWAY,ESPLANADE WEST._,. LA_QUINTA• CA 92253 Permit MECH POOL, Additional desc:.. Permit" Fee -24:.D0 Plari• Check' Fee 6.00 Issue Date. Valuation . . . 0 Qty Unit, Charge Per t;. Extension BASE -FEE. 15.0 0 1.00 9.:0000 EA MECHFURNACE.',<=10*0K 9.00 Permit. BLDG POOL,PERMIT'• Additional desc. Permit Fee . . 207.0.0 Plan Check'Fee 134.55 Issue Date Valuation "20000. Qty Unit Charge Per '' Extension BASE FEE,' #5.00 r_.ep .�_... 4 y.,. ) 18.00 9.0000'THOU° BLDG 2;001-25fM1r,000 162.00 Permit ELECPOOL ' PERMI'T 'RES" " ' Additional desc Permit Fee '45.00: Plan, Check..Fee 11.25 Issue' ­'Date ` . Valuationsaw I 0 t y Ji Qty Unit Charge Per �" Ex+I ension BASE FEE! 15.00 1.00; ..30..0000 ;EA_ ELEC PRIVATE SWI1. MING r . OV 2 2004 lJ 30.00 --------------------------------- -- --- - - - - ---- -- - ------ Permit PLUMBING : - - C9ry®1 LA®d11�1�G Additional desc FltdA►dCE®EP'f Permit, Fee 33:00. PI'ari "Check Fee 8.25 Issue Date VaIuatio* n 0 Qty Unit Charge Per'. Extension BASE FEE. 15.00 P.O. BOX 1504 44 y, 4 VOICE (760) 77'7-7012 78-495 CALLE TaMPlco FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: .Date: Applicant:. I Arrhifarf nr GnninLn. . Applicant's Mailing Address: Lic. No.: t3UILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of pedury that 1 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 thepplicant 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. .13A P.C. for this reason V Date - WORKERS' COd PENSATION 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 th, should be co subject to the wo s' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those prov' ions. Date ' � 6 V lgpplicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAW ND 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 Lender's 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 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 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 enter upo above -menti ned property for ins coon purposes. Date Signature (Applicant or Agent): 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 ie quired to.be signed by property owners unless.they are:pe. onally performing their own work. If yourwork.is being'performed.by..someone othertk an yourself, you may protect yourself from possible liability if that person applies for ihe. 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 lawto 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 plan to:subcontract, you should be aware of the following information foi: your benefit and protection: . If you employ or otherwise engage.any persons ocher 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.andFederal.Government as anerriployer-and you are subject to several. obligations including'Site and Federal income: taz withholding,'federal' sociafsecurity taxes, worker's compensation insurance, disability: insurance costs and urierimployment`compensationcontributions. 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, contactthe,Internal'Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For mote 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 . ab licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing.ro,be contractors is to secure.an "Owner /Builder" building permit, erroneously implying. that the property owner is providing hisor her own'Aabor 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.058W. Please complete and return the enclosed owner -builder verification form so that we•can confirm that you are aware of A 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 Q -gy v OWNER'S SIGNATU /DATE y3lot tg,.lrwcw Lsnla,nndc PROPERTY AdbR8s PERMIT NUMBER(s) Y^ . Page 2 Application'Numbe-r . . 04.-0000752:3 Date 12/01/04 Qty Unit .Charge P'er Extension 2.0.0 6:`0000 EA PLBs•:PIXTURE12.00 1 . 0.0 3 ..00.00. EA -. PLB,. WATER -INS .. 3.00 . 1.0.0 .3..0000 EA P,LB GAS PIPE ;1•-4. OUTLETS 3.00 -------------------------------- Special Notes -- .--;---------------------------------------- and Comments POOL & SPA ONLY. ALARMS/BARRaLERS SHALL BE ' IN PLACE PRIOR 'TO 'f:PREPLASTER", INSPECTION. r , EQUIP.MENT.ENLCOSURE'-NOT INCLUDED IN P:ERMIT., Fee summary Charged Paid,., Credited Due Permit Pee Total . 309.00 ...00 0:0 309.00 Plan Check, 'Total' -160:..05 .00 .00 160.05 . Grand Total 469:.05 Y...00' <:00 469.05