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04-5018 (RPL)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE .TAMP_ICO FAX (760) 777-70.11 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number � _0000'5"OF8,_ Date 6/17/04 Property Address C -50235 -VIA SIMPATICO APN: 772-400-018- - - .Application description �POQL� ---=RES*IDENTIAL Property Zoning . . .. LOW LbENSI+TY RESIDENTIAL TApplication valuation_ 1500,0 JUN 2 4 � 11 2�� i Owner Contractor ------------------ - - - --- -=---- -- CITY UFQ.l�QIliidTrd'_-.------- - - - -- R J T HOMES�JEPT. RJT HOMES LLC 1425,E UNIVERSITY DR 1425 E. UNIVERSITY DRIVE . PHOENIX AZ 85034 PHOENIX AZ 85034 WCC: STATE'FUND WC.: 1583906 .10/01/04 CSLB: 690645 06/30/04 CCC: A -B Permit MECH POOL Additional desc . Permit Fee .. 24.00 Plan Check Fee 6.00 Issue Date Valuation 0 Qty Unit Charge. Per Extension ° BASE FEE 15.00 1.00 9.0000 ----------------------------- EA MECH FURNACE <=100K 9.00 Permit .. BLDG POOL.PERMIT Additional�desc . Permit Fee ... 162.00 Plan Check Fee 105.30 Issue Date Valuation : . . 15000 Qty Unit Charge Per Extension BASE FEE 45.00 13.00 9.0000 ----------------------------------------------- THOU BLDG 2,001-25,000 "7 ---=------------------------ 117:00 Permit . . . ELEC POOL PERMIT -RES Additional desc . Permit Fee . . . 45.00 Plan Check Fee 11.25 Issue Date. . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATESWIMMING POOL 30.00 t P.O. BOX 1504• UWA V VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: Applicant: — Applicant's Mailing Address: Architect or Engineer: Architect or Engj a Ad ss: 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 i in full force and effect.- /k License Class A- License No. (qQ, S Date &-e)-7 "'0 -/ 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 owner -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, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self4nsure 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. 1 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 issueq. My workers' co pensation insurance carrier and o i rare Carrier s-4.1^� to N Policy Number num _ / 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 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. —0u /Tsynh Jr1ii;-1X1— WARNING: FAILURE TO SECURE WORKERM' COMPENSATION COVERAGE IS UNLAWFUL, AND 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 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 oorrecL I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county o enter upon the above-mentioned property for inspection purposes. . Date (� �� 6q Signature (Applicant or Agent): Page 2 Application. Number, 04-00005018 Date 6/17/04 Permit MING Additional'desc Permit Fee 33.00 Plan Check Fee 8.25 Issue Date Val=uation . . 0 j Qty Unit Charge- Per Extension = BASE FEE 15.00 2.00 6.0000 EA PLB FIXTURE 12.-00 1.-001 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 PaidCredited.. Due 1. Permit ' Fee' Total 264.'00 .00 .00 264.0'0 Plan-Check Total 130.80 .00 -.00 .130.80 Grand Total 394.80 .00 ..00 394.80 f A E-INFECTION. FEE OF $30 WIL BE CHARGEn THE APPROVED CITY O ! NTA `PLANS JOB CARD ARE NOT N . BUILDING SAFETY D THE SIT OSA.. SCH-EDUID AP oR0\/�p. 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