09-0567 (RPL)81307 Amundson Ave
09-0567
111111111111 III11111111130
IE
P.O. BOX 1504 -- -
78-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
Application Number:
09-00000567
Property Address:
81307 AMUNDSEN AVE
APN:
767-690-020- - -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
75000
Ti&t 4 4 a"
Applicant: Architect or Engineer:
F*hmw.j "".01C-1UX-L ViRomekko
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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UCENSE CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I a censed under provisions of Chapter 9 fcummeii6 ig with
Section 7000) of Division 3 of the Business a Professionals Code, and my License is in full force and effect.
License Class: B License No.: 848057
Dater Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perj y 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 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 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
Owner:
MICHAEL H GRAY
PO BOX 9935
NEWPORT BEACH,
TRUST
CA 9265
Contractor:
BRADSHAW CONSTRUCTION
46248 ROUDEL LN
LA QUINTA, CA 92253
(760)347-4246
Lic. No.: 848057
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/18/09
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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 DELOS INS Policy Number 01DKRM22005875
certify that, in the performance of a work for which this permit is issued, I shall not employ any
person in any manner so as to come subject to the workers' compensation laws of California,
and agree that, if I should b me subject to the workers' compensation provisions of Section
3700 of the Labor Code, I all forthwith comply with those provisions.
Op
Date: 0 Applicant:
WARNING: FAILURE TO SECURE W RKERS' 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.
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 i ormation is correct. I agree to comply with all
city and county ordinances and state laws relating to building co truction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for ' spection purposes.
Date: 0 -/94 Signature (Applicant or Agent): _ —
Application Number . . . . . 09-00000567
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee 527.00 Plan Check Fee
342.55
Issue Date . . . . Valuation'
75000
Expiration Date 12/15/09
Qty Unit Charge Per
Extension
BASE FEE
414.50
25.00 4.5000 THOU BLDG 50,001-100,000
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112.50
Permit . . : ELEC POOL PERMIT -RES
Additional desc.. .
Permit Fee . .'. . 45.00 Plan Check Fee
11.25
Issue Date Valuation . . .
. 0
Expiration Date-. 12/15/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL
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30.00
Permit PLUMBING
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
7.50
Issue Date . . . . Valuation . . .
. 0
Expiration Date 12/15/09
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
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Special Notes and Comments
1,690SF/20,000GAL STREAM FEATURE AT REAR
OF PROPERTY. THIS PERMIT DOES NOT
INCLUDE BRIDGE CROSSING, STACKED ROCK
WALL OR BLOCK WALLS. ENGINEERING BY
WATERSCAPERS - 2007 CBC.
June 18, 2009 4:20:52 PM AORTEGA
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Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
3.00
Fee summary Charged Paid Credited
---------------------------
Due
------------------------------
Permit Fee Total 602.00 .00 .00
602.00
Plan Check Total 361.30 .00 .00
361.30
LQPERMIT
Application Number
Other Fee Total
Grand Total
LQPERMIT
09-000005.67
3.00 .00 .00 3.00
966.30 .00 .00 966.30