04-4023 (RPL)eT .
BUILDING & SAFETY,DEPARTMENT
c m 4g B 1504 (760).777-7012
�At p 5 LE TAMPICO FAX (760),777-7011
O 121UI CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
spy BUILDING, PERMIT
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C\r A�IC�O��
Ap lic n Number .04-00004023 Date .5/11/.04
Pr erty Address . . . . . .78390 VIA SEVILLA
APN:' 604-201-021-21 -23971 -
Application description... 'POOL - RESIDENTIAL
Property Zoning LOW DENSITY.RESIDENTIAL•
Application valuation 22500
Owner Contractor
CENTURY AMERICAN DEV CORP OWNER
1430 E CHAPMAN AVE
ORANGE CA 92866
Permit BLDG POOL PERMIT
Additional desc
'Permit Fee 234.0.0 Plan Check Fee 152.10
Issue Date Valuation 22500
Expiration Date.. 11/11/04
Qty Unit Charge Per Extension
BASE.FEE 45.00
21.00 9.0000 THOU BLDG 2,001-.25.,000. 18.9.00
Permit.MECH POOL
Additional desc
Permit Fee 24.00 Plan -Check Fee 6.00.
Issue Date Valuation 0
Expiration Date 11/11/04
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 9.0000 EA MECH FURNACE <=100K 9.00
----------------------------------------------------------------------------
Permit . . ELEC POOL PERMIT -RES
Additional desc
Permit Fee 45.00 Plan Check Fee'. 3.75
Issue Date Valuation 0
Expiration Date 11/11/04
,Qty Unit Charge .Per Extension
BASE FEE 15.00
1.00 30•.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
Py
P.O. BOX 1504 • "
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QuINrA, CALIFORNIA 92253 4 4 a
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: e:W 3
Applicant:
Applicant's Mailing Address:
Date:
Architect or Engineer:
Architect or Engineer's Ad s:
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
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
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 owrier-builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U 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, an o contracts for the projects with a contractors) licensed pursuant to
the Contractors' State License Law.).
U I am exempt unper Sec. , BA P.C. this reason
Date Owner 1
W RK S' OM ATION DECLARATION
I hereby affirm under penalty of perjury one of the following decl ations:
_ I have and will maintain a certificate i consent to set • e 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:
Cartier 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 agr that, if I should become subject ers' pensation provisions of Section 3700 of the Labor Code, I shall
fo/ comply with those provisions.
Date �r Applicant*
WAR9'1N FA URE TO SECURE WO E COMPENSATION COVERA I LA AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED TH AND DOLLARS ($100,000), IN ITION 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.).
Lenders 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.
1 certify that I have read this application and state that the bve info on is correct I agree to comply with all city and co ordinances and state laws relating to building
construction, and hereby authorize representatives of thit r upon the above- mmention o rty for ins purposes.
/1 Jam% �
Date V I Signature (Applicant or Agent;)*.-
A,
Page 2
Application Number
04-00004023
Date 5/11/04„
Permit ... . . . .
PLUMBING
Additional desc'
Permit Fee
Permit
33.00
Plan Check Fee
8.25
Issue Date . . . .
Valuation
0
' Expiration Date
11/11/04
Qty Unlit 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
-Fee-summary Charged
Paid Credited
Due
Permit Fee Total.
336.00
00 00
336.00
Plan Check Total
170.10
.00 00
170.10
Grand Total
506.10
.0.0 .00
506.10
i.
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CITY OF LA QUINTA SUB—CONTRACTOR IST
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' JOB ADDRESS 78�-1� �1 �'A �C 1uA
PERMIT NUMBER f OWNER IN' l.� BUILDER
..This form shall be posted on the job with the Building
jnspection 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-clianges to this list must be approved by the Building Division prior to commencement
of work. failure to,coinply will result in a stoppage of
`
work,and/or the voidance
I.of building., permit. For each applicable trade, all information requested below must be com leted
9P p
by`.applicant. • "On File" isnot°an acceptable*response:
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La,(��
..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 required to be signed by property owners unless they are personally performing their
own work.. If your work is being performed by someone other than yourself, you may protect yourselffrom possible
liability if'that person applies for the proper permit in his or her name.
Contracto{UCarre reg,uired�by,l�awit o/be licensed and bonded by the State of California and to have a business license
from the City or Counry. They, are also required by law to put thein 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 subcdri tact, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and'ihe 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 and, Fedeial Government as an employerand you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
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, contact the Internal Revenue Service (and, if 4
you wish, the US. Small Business. Adminstration). For more specific'information about your obligations under State
Law,)Icontact 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 a licensed contractor or subcontractor, only under limited
conditions.
A frequentpractice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor. 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 95814.
Please complete and return the enclosedowner-builder verification form so that we can confirm that you are aware of
these matters. The building permit -will not be issued until -the verification is -returned. - .- -
Very. truly,yours, y
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY.
78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
FAX 760) 777-70M
NER'S SI iZE/D®
PROPERTY ADDRESS
PERMIT NUMBER(s)