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05-2011 (RPL)1 P.O.' BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 . BUILDING PERMIT ' ' Date: 5/25/05 Application Number: 05-00002011. Owner- Property Address: 44795 VIA CATALINA - RUIZ APN: 604-032-999-77 -305212- 44-795 VIA CATALINA Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL t Application valuation: 25000 Dw Contractor: Applicant: �, Architect or Engineer p� O 1 Owner • ---------------------- �1�N�DI.A , LICENSED CONTRACTOR'S DECLARATION - - - WORKER'S COMPENSATION DECLARATION' - r 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 Division 3 of the Business and 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 License Class: ' - License No.: - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Date: Contractor. - _ - I have andwill maintain workers' compensation'insurance,.as required by Section 3700 of the Labor - • Code, for the performance of the work for whichthis-permit is issued. My workerscompensation - 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 Carrier - Policy Number following reason (Sec. 7031.5, Business and Professions Code:. Any city or county that requires a permit to I certifythat, 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 �sub•pj�ect.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 beco --"7- the or r 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 Cod all forth rth co hose 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 ($500),:- 1 _ 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- WARNING: FAILURE. TO SECURE WORKERS' COMPENSAT19p OVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply-to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL 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). IN ADDITION 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 O I, 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 does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed A. 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 under or pursuant to any permit issued as a result of this application, ^ (_) I am exempt under Sec. , B.&P.C. for this r 1 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: 0 er' - '/ 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 - CONSTRUCTION L LADING AGENCY - - permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending a or the performance of the. I certify that I have read this application and state that the above informat correct. I a t mply with all work for which this permit is issued (Sec. 3097, Civ. C.). 'city and county ordinances and state laws relating to building co ton, d her represen 'ves of thi county to enter upon the above-mentioned pr art mspectio urp Lender's Name: Ep2�O nature (Applicant or Agent)- .. Lender's�Address: LQPERMIT Application -Number . . . . . 05-00002011 " Permit . . . BLDG POOL PERMIT Additional desc . Permit Fee 252.00 Plan Check Fee - .163.80 - Issue Date Valuation 24840 - Expiration Date 11/21%05 Qty. Unit Charge Per Extension BASE FEE 45.00 23.00 9.0000 THOU BLDG 2,001-25,.000 207.00 Permit MECH POOL Additional desc . Permit Fee 26.00 Plan Check Fee .6.50 Issue Date . . . Valuation . . . . 0 Expiration Date .. 11/21/05 ' 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,. 11/21/05 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 11/21/05 QEy. 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 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 Permit WALL/FENCE PERMIT LQPERMIT - . Application Number . . . . . 05-00002011 Permit WALL/FENCE PERMIT Additional desc . Permit Fee. 15.00 Plan Check Fee.. .00 Issue Date . . . . Valuation . . . . 160 Expiration Date .' 11/21/05 Qty Unit Charge Per Extension BASE FEE 15.00 --------------------------------------------------------------------- Special Notes and Comments POOL & SPA ONLY. 10 L.F. 4- BLOCK WALL, CITY STANDARD: ALARMS/BARRIERS SHALL -BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT - INCLUDED IN PERMIT. Fee summary Charged Paid Credited Due' Permit' Fee Total 371.00 .00 .00 371.00 Plan Check total 189.80 00 .00 189.80 Grand Total 560.80 .00 00 560.80 LQPERMIT . n CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS r qSy1A `A1-A"AIA PERMIT NUMBER 05- -.2-otl_ OWNER KC11 Z BUILDER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File"'is not an acceptable response: Trade / Classification Contractor' .;.. :77=. ;:.;:::.::.. •:::::. <;:.:: :.<>< State..Contractor s. License . Woikeis.C.om ns :` ` : :.. ::;..:. Busine Li' . City ss cense::.::. Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK 1C-121 :.: ru-Ai p !� 3� �� ar D 1 O CONCRETE (C-8) STRUCT. STEEL (C-51)� a MASONRY (C-29) PLUMBING (C -36)'/Z S -e rjj7r(� G�3 3 ( %, '� S� b D D D / L 3 PLASTER (C-35) DRYWALL (C-9) .:. 4 HVAC. (C-20):::.:.:... 1' ` ELECTRICAL. (C=10) : ,.: 1.145MQ = /,� 3S�b 3 3 T ,� (�3b60 067(7 ROOFING IC=39)::` .:::! s'.• :SHEET METAL (C=43) FLOORING (0=:15): ..... .. GLAZING IC -17Y.. ' INSULATION '(C-2) . SEWAGE DISP; (C-42) PAINTING (C=33) f CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) LANDSCAPING (C=27) '. POOL (C-53) �i �. (L t� Gs.3 ..LCtr, 7hJ106 Stx& /cc i! Dc-f�a—OGI& /1 CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS' 7 -.�9� V l A LATA( -1^4A PERMIT NUMBER Q3` ,2o 6/ OWNER BUILDER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in'a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an accentahlP resnonse: Classification Contractor .:' :Contractor sLicense . .WrmraionIrur . Cit -Business nets LicenTrade Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies),✓ Exp. Date' (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK 1C-121 :.: e Q ae L �3 v 5Z r"Ax O % 3OJ or l� l 3 0 CONCRETE (C-8) FRAMING 'IC -51 STRUCT::STEEL (C -51)a S635 � STT Aeyb 64k D 667121t)I 0( MASONRY (C-29) PLUMBING (C-36)' 15rb C6/11/64 % g- S� j,(a� D / f5l 3 6sa PLASTER (6-35) DRYWALL (C-9) .:. : HVAC. (C -20) :::: ELECTRICAL. (C.10) '..: I.1,6 7Q = /�L 3�vrb 3 g TittPt �e i s3b6O 6 ROOFING.(C 39):` ".:.'°'<.: SHEET METAL (C=43) FLOORING (C-:15): GLAZING IC -171: INSULATION (C-2). SEWAGE DIsP: (C-42) PAINTING (C=33) CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) LANDSCAPING (C-27) POOL (C-53) IV, 6 ^. Le 1 � �S3 .. C-rLc3` C�7%�J/1D�o _S -f-,,&_ iccii D`��o —OGI� `� /��6