06-0508 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t!t 4 4QurMrw
Applicant: Architect or Engin'ee)r:
LICENSED CONTRACTOR'S DECLARATION
S 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: C53 License No.: 862797
,.----Date: Cont ctor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that t?e or she is, Xempt 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).:
( _°j-+1, 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_,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.).
(_ I I am exempt under Sec. , B.&P.C, for this reason
CONSTRUCTION LENDING AGENCY
I hereby affirm unCer 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:
w, Lender's Address:
Y
LQPERMIT
ARTMENT
11T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/01/06
Owner:
DEMPSEY , MORK/PATTY
55051 RIVIERA
LA QUINTA, CA 92253
Contractor:
BAHAMA POOL COMPANY
15240 VIA MONTANA
DESERT HOT SPRINGS, CA 92240
(760)329-9273
Lic. No.: 862797
------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty 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.
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:
Carrier EXEMPT Policy Number EXEMPT
Dcenify 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 beco a subject to the workers' compensation provisions of Section
3700 of he Labor Code, I sh forthwith comply ith those provisions.
WARNING: FAILURE TO SECURE WdRKER$' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 0100,000). 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 co y ordinances and state laws relating to buildin const ction, and hereby authorize representatives
of this my to enter upon the above-mentioned propert or�in;ecb puy�ses.
�6DWE
Application Number:
06-00000508
��j��6
Property Address:
55051 RIVIERA
�y
p
APN:
775-153-018-F
LA ®����
Application description:
POOL - RESIDENTIAL
f,P"ORIC����
Property Zoning:
MEDIUM HIGH DENSITY RES
FINS►
Application valuation:
25000
Applicant: Architect or Engin'ee)r:
LICENSED CONTRACTOR'S DECLARATION
S 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: C53 License No.: 862797
,.----Date: Cont ctor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that t?e or she is, Xempt 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).:
( _°j-+1, 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_,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.).
(_ I I am exempt under Sec. , B.&P.C, for this reason
CONSTRUCTION LENDING AGENCY
I hereby affirm unCer 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:
w, Lender's Address:
Y
LQPERMIT
ARTMENT
11T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/01/06
Owner:
DEMPSEY , MORK/PATTY
55051 RIVIERA
LA QUINTA, CA 92253
Contractor:
BAHAMA POOL COMPANY
15240 VIA MONTANA
DESERT HOT SPRINGS, CA 92240
(760)329-9273
Lic. No.: 862797
------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty 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.
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:
Carrier EXEMPT Policy Number EXEMPT
Dcenify 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 beco a subject to the workers' compensation provisions of Section
3700 of he Labor Code, I sh forthwith comply ith those provisions.
WARNING: FAILURE TO SECURE WdRKER$' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 0100,000). 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 co y ordinances and state laws relating to buildin const ction, and hereby authorize representatives
of this my to enter upon the above-mentioned propert or�in;ecb puy�ses.
Application momber . . . . . 06-00000508
Permit .
. . . . . BLDG POOL eEoMzr
Additional
deoo
Permit Fee
. . . . 252.00 eIao Check Fee .
. 163.80
Issue Date
. . . . Valuation . . .
. 24740
Expiration
Date . . 7/31/06
.
Qty Unit Charge Per
Extension
BASE FEE.
«s.00
23.00
------------------------
9.0000 raOo BLDG 2'001-25'000
---------------------------------------------------
207.00
Permit .
. . . . ' MECH POOL .
Additional
.
deao
Permit Fee
. . . . 26.00 Plan Check Fee .
. 6.50
Issue Date
. . . . Valuation . . .
. O
Expiration
Date . . 7/31/06 '
Qty Unit Charge Per �
Extension
BASE Foo '
15'00
1.00
------------------�-_------------------�--�---------------------------------
11.0000 EA MECe FURNACE >100K
11.00
'
Permit .
_
. . . . . ELoC POOL PERMIT -RES
Additional
deoc . .
Permie Fee
. . . .«5.VV Plan Check Fee .
. 11.25
Issue Date
. . . . Valuation . . .
. O
Expiration
Date . . 7/31/06 _
'
Qty Unit Charge Per '
Extension
aaaE FEE
15.00
' 1.00
------------------------_-------------------------_-------------------------
30.0000 EA oLoC Paz\Aro SWzMmzrw]'eOOL
30.00
~/ Pezmit . .
. . . . eLlnnazmG
Additional
deoo . .
Permit Fee
. . . . 27.00 Plan Cbeok.Fee .
. 6.75
Issue Date
. . . . Valuation . . .
. O
Expiration
Date . . 7/31/06
Qty Unit Charge Per �
Extension
-
BASE FEE
15.00
1.00
6.0000 oa gLo FIXTURE
6.00
1.00
3.0000 EA gLB WATER Im8z/xuLz/RoP
3.00
' 1.00
-------------------------------------------------------------------'--------
3.0000'EA gLo GAS PIPE I~4 OUTLETS
3.00
eezmdt . .
. . . - WALL/FENCE eoaMIz
LQPERMIT
Application Number . . . . . 06-00000508
Permit WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 15.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 260
Expiration.Date 7/31/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL WITH HEATER. 12 L.F. 5' WALL, CITY
STANDARD. GAS LINE STUB FOR FUTURE
APPLIANCE. ALARMS/BARRIERS SHALL BE IN
PLACE PRIOR TO PRE -PLASTER INSPECTION.
Fee summary Charged Paid
-----------------
Credited
Due
---------- ----------
Permit Fee Total 365.00
----------
.00.
----------
.00
365..00
Plan Check Total 188.30
.00
.00
188.30
Grand Total 553.30
.00
.00
553.30
LQPERMIT
Bin #
cltybf U Quints -
Building 81 Way Division
P.O. Box 1504, 78-495 Calle Tampico
Permit #
J�0t
La Quinta,- CA 9225-3 -,(760) 777-7012
-Building Permit Application -and Tracking. Sheet
,LojectAddress:''Sy6l Z ilj1
ner's Name
DeF &e 4 o a -
A. P. Number:
;Ow
�ddress3
Legal Description:
iPitY._STj-Zip-
-44
Contractor
A
je�lephon�:.
;r7i e7c CD
-Vcr:`i��fion: -vL,4
LA dllVe s- ,2 46 VIA N V /
F17, �_Tzw V.0 &Aj;re 4A TZ) V 6
w SEM=,
CTe 176 pA—on e. 2&0 E
[State =C#
T
Arch.,-Engr., Designer:
-z
ZT4a
Address:
City, ST, Zip:
Telephone:
Con"struction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
�of(;6:7ntfact-Person:r mq�
Sq. Ft.:
# Stories:
# Units:
.Telephone-#To–f'CFnta—ctP,e7Eson:
7
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec!d
TRACKING.
PERMIT FEES
Plan Sets
Plali. Check submitted
item
Amount
Structural Cales.Plan
Reviewed, ready for• corrections
Check Deposit'.,
Truss Ca1c;.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
-Plans resubmitted
Mechanical
Grading. plan
2"d R , eview" ready for corrections/issue
Electrical
Subcontactor List
Called -Contact Person
Plumbing
Grant Deed
Plani picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Inipaict Fee
Planning Approval ,
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
F_7
'total Permit Fees
CITY OFLA GUINTA SUB -CONT. ACTOR
LISA
JOBADDRESS'PERMIT
, �"UILDER
NUMBER fb -,5- WNE
I
This form shall be- posted
on the job with the Building
Inspection .Card at all times in a conspicuous glace. Only'
person ring 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.
T / as
rac o .:
Cont t r
::::>::;.>.>':<;:r::<:>.::
:..::....::.:SiSt ate::Contractor.s. Lrcense .. .;..
.
W..o�ke�s.C�m er�sation;Insu�ance:..:` :`..:.-
City Business. License::.::
Company Name
Classification
License Number
Exp. Date
Carrier Name
Policy Number.
Exp. Date .
License Number.'
Exp. Date
(e.g. A, B, C-8)
(x]xxxxxxx)
(xx/xx/xx)
le.g. State Fund, CalComp)
(Format Varies)
(xx/xx/xx)
(xxxx)
(xx/xx/xx)
EARTHWORK (C-12) :.:
LJ�
Ci
— {o(T !
s� a
�a3
CONCRETE (C-8)
FRAMING 1C-5).:::
$TRUCT: STEEL (G-51)
4Y _62
R3110 .
MASONRY (C-29)
PLUMBING (C-36)
PLASTER (C-35)
�, -
t!oS
a
o2,r
`t
DRYWALL (C-9).:.
HVAC. (C-20)'.::.<`..:`:.
ELECTRICAL. (C-1 0) ; .• .
J
b (q //
�1J✓?/ V
�%�3yY
U 7/22
RQOFING'iC=39)
SHEET METAL(C43) ... '
FLOORING (0:15):
GLAZING
INSULA TION:(C-2) .
t
SEWAG15 DISP (C-42) ,
33)
PAINTING (C=7.
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C713) `
LANDSCAPING (C=27).
Af` POOL IC -531
C_- '. PJ
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d. l aZ'
�0 / d(r
Q
�$
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