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05-1862 (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: 05-00001862 79850 DE SOL A SOL 772-390-047- - - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 15000 Ta�v 4 4a Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: DtMAY::.19 A R J T HOMES r�� 1425'E UNIVERSITY DR PHOENIX, AZ 85034 2005Ov L,4OWNT�A FINANCE DEPT. Contractor: - RJT HOMES LLC WCC: 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: 5/16/05 -----------------------7------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION 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 Div' ion 3 he Business and Professional's Code, and my Licen�5�-is ''j� ull §c and ffect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided / License Class: 'r" License NO.: ,} i'S (� for by Section 3700 of the Labor Code, for the performance of the work for which this permit is } issued. S' .Date: S "/" D 7Contractor� t LC c 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 L I-C.rier A -B Policy Numb,, - - - - - - - - - - - - - - - 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 pursuant to 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 Code, I shall forthwith comply with those provisions. 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 (5500) -:ate: ee- . Applican •- (_ 1 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 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 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.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: 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: LQPERMIT 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 (5100,0001. 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 comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives oft/hi/s e6unty to enter upon the above-mentioned prop rty f ins'on rposes. D t� e: 5-l9" ✓ Signature (Applicant or Agen . Application Number . . . . . 05-00001862 Permit . . . BLDG POOL PERMIT Additional desc . Permit Fee 162.00 Plan Check Fee 105.30 Issue Date . . . . Valuation . . . . 15000 Expiration Date 11/12/05 Qty Unit Charge Per Extension BASE FEE 45.00 13.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 117.00 Permit . . . MECH POOL Additional desc.. Permit Fee . . . . 26.00. Plan Check Fee 6.50 Issue Date . . . . Valuation 0 Expiration Date 11/12/05 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 11/12/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 -------------------------------------------- EA 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 11/12/05 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 ---------------------------------------------------------------------------- Special Notes and Comments POOL & SPA ONLY. GAS STUB/ELECTRIC FOR FUTURE APPLIANCE (BY SEPARATE PERMIT). ALARMS/BARRIERS SHALL BE IN PLACE PRIOR LQPERMIT Application'Number . . . . . 05-00001862 ---------------------------------------------------------------------------- Special Notes and Comments TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSUE NOT INCLUDED IN PERMIT. Fee summary Charged ----------------- ---------- Permit Fee Total 266.00 Plan Check Total 131.30 Grand Total 397.30 LQPERNIIT Paid Credited Due ---------- ---------- ---------- .00 .00 266.00 .00 .00 131.30 .00 .00 397.30 FA ffi rq 1 1 LU U= . u CO m z�-ar �. D<p o. 3r r o 35: k 23.