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05-1728 (PLBG)ffi T P.O. 1504 BUILDING & SAFETY DEPARTMENT A (760),777-7012 �-4 LLE •rAMPICO FAX (760) 777-7011 A " IQUIN , CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number 05-00001728 Date 5/05/-05 Property Address 60738 WHITE SAGE DR APN: 764-270-999-103 -300231- Application description PLUMBING Property Zoning . . . . . . . MEDIUM HIGH DENSITY RES Application valuation . . . . 150 Owner Contractor --------------------------------- ------------------------------------ EKMECHIAN DEVINE SWIMMING POOL DESIGN 60-738 WHITE SAGE DR. 80844 BOULDER DRIVE LA QUINTA, CA 92253 INDIO, CA 92201 (760)989-0354 WCC: STATE FUND WC: 1641733 07/01/05 CSLB: 786814 11/30/06 CCC: C53 P.O. Box 1504�� VOICE (760) 777-7012 78-495 CALLE TAMPICO T4hf 4 4 FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date:. -5/ 510 5 Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 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 and Professionals Cade, and my License is in full Force and effecl.t License Class�� _ "License No. S-17 Date --Contractor 5 � 0011 �F"vim r` 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, of repair any structure, prior to its issuance, also requires the applicant for the permit to rite a signed statement that he or she Is licensed pursuant to the provisions of the Contractors' State Ucense 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 live 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 Cade: The Contractors' State License Law does not apply to an owner of property who builds or Impmves thereon, and who does the work himself cr 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 avid will iii i uiie yeei of cup PPI etluii, the owne r- bu lid or will have the burden of proving that he or sne did not build or improve for the purpose of saIs. )- 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' Slate 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- . BA P -C- for this reason Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penally 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. t 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, M workers' camp ensatior) insurance carrier and policy number are: Carrier __ X.R l�olicy Number _ 14=U i f -�� 1 cerli y hat, 'the performance of the work for which its permit is issued, I shall not employ any person In any manner so as to became 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. Dale _4r Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECTAN 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 I MPO RTA N T Applica ban Is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth an this application. 1- Each person upon whose behalf Ih.is application is made, each person at whose request and for whose beneFt work Is performed under or pursuant to any permit issued as a result of this application, the owner, and thea ppi [ca nt. 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 we* being performed under or following Issuance of this permit, 2. Any permit issued as a result of Phis application becomes null and void If work is not commenced within 188 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancella Ion. I ceftify that I have read this application and stale that the above information is correct. I agree to comply with all cfty and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes- -k)ate —Q Egnature (Applicant or Agent): � ��_ ---------------------------------------------------------------------------- Application Number . . . . . 05-00001728 ----------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc . Permit Fee 18.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 11/01/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments 60 LF. GAS LINE FOR FUTURE BBQ Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 18.00 .00 .00 18.00 Plan Check Total .00 .00 .00 .00 Grand Total 18.00 .00 .00 18.00