06-2573 (RPL),, ,,,.�,. v IIIIIIIIIIIIIIIIIIIIIIIII 19 II
P.O:'BOX 1504 IE
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 06-00002573
Property Address: 60875 AZUL CT
APN: 764-270-999-87 -300234-
Application description: POOL - RESIDENTIAL
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 104000
T4ht 4 4 Q"
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Businesl and Professionals Code, and my License is in full force and effect.
License Class, C53 �---License No.: 518742
/te: (0 �ontr or:
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 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 155001.:
(_) 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.).
(_) 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.).
( ) I am exempt under Sec. , BAP.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:
MIKE ROGERS
60-875 AZUL CT
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/30/06
------------------
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.
IL 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 STATE FUND Policy Number 0001188-2005
_ 1 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 t rkers' compensation provisions of Section
3700 of the Labor Code, I all forth oo�mlplyy with those provisions.
Dat
a Applicant:
WARNING. FAILURE TO SECU W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TOC AL 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 theCity
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 county ordinances and state laws relating to'ding construction, and hereby authorize representatives
of this cote upon the above-mentioned Pr rtY for in s s.
Date: 6 Signature (Applicant o e
o a �
Contractor:
AMERICAN POOL CONSTRUCTIO
C
6 2006
P.O. BOX 11996
AUL 0
PALM DESERT, CA 92255
(760) 340-2588
C. Or. LAQUI14TA
Lic. No.: 518742
iitN EDEPO
------------------
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.
IL 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 STATE FUND Policy Number 0001188-2005
_ 1 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 t rkers' compensation provisions of Section
3700 of the Labor Code, I all forth oo�mlplyy with those provisions.
Dat
a Applicant:
WARNING. FAILURE TO SECU W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TOC AL 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 theCity
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 county ordinances and state laws relating to'ding construction, and hereby authorize representatives
of this cote upon the above-mentioned Pr rtY for in s s.
Date: 6 Signature (Applicant o e
Application Number . . . . . 06-00002573
Permit
BLDG POOL PERMIT
Additional
desc .
Permit Fee
. . . .
653.50 Plan Check Fee
424.78
Issue Date
. . . .
Valuation
104000
Expiration
Date
12/27/06
Qty
Unit Charge
Per.
Extension
BASE FEE
639.50
4.00
-------------------------------------------------7--------------------------
3.5000
THOU BLDG 100,001 -UP
14.00
Permit
MECH POOL
Additional
desc . .
Permit Fee
. . . .
26.00 Plan Check Fee
6.50
Issue Date
. . . .
Valuation . .
. 0
Expiration'Date
12/27/06
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
12/27/06 -
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..
12/27/06
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
1.00
----------------------------------------------------------------------------
3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
Permit .
. . . . .
WALL/FENCE PERMIT
LQPERMIT
Application Number . . . . . 06-00002573
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 21.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 749
Expiration Date 12/27/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
3.00 2.0000 HND BLDG 501-2,000
6.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA WITH14 LF' 4' HI WALL & 21 LF.
6' HIGH BLOCK WAL CITY STANDARD.
INCLUDES 63 LF. 10" HIGH WALL (COURTESY.
INSPECTION)
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 778.50 .00
.00
778.50
Plan Check Total 450.78 .00
.00
450.78
Grand Total 1229.28 .00
.00
1229.28
LQPERMIT
06/30/2006 12:22 7606749438
Bin #
Permit #
Project Address D_
k P, Number:
Legal Description:
Contractor.
Address:
City, ST, Zip:
Tc,[T[ ono:� ?
State Lia. #
Atch•. Engn, Designer:
Address:
City, ST. Zip:
Telephone:
State Lig. #:
Namc of Contact Pelson:
Telephone # of Contact Pets6a:
# Submittal
Plan Sets
Structural Calat.
i russ Cala.
Energy Cales.
Flood plain plan
Grading plan'
Subcontactor List
Grant Deed
H -OA. Approval
IN ROUSE:
rlanning Approval
Pub. Wks.Appr
School Fees
ows 7N 7 p
Peot 1e"Urj
AMERICAN POOL CONST
City of La Quinta-
Building 8L Safety Division
P.O: Box.1504, 78-495 calle Tampico
La Quanta, CA 922.53 -.(760) 777-.7012
Building Permit Application and Tracking Sheet
Owner's Name: S
Address: 60—
Ctty, ST, Zip: (�T
Project Description_
ty Lic. N: A
`hc lL
PAGE 01/0
Construction type:
` Occupancy:
Project type (cit+cle one):
New Add'n Altar Repair Dcmti
Sq' Pt:
#Stories:
# Units:
�ZS
Estimated value of Proj& t CU 01121
APPLICANT: Do NOT WFIrM.BEiOW THIS UNE
Itec'd
TRACING
PERMIT FEES
Plan Check subtgitted
•
Item
Amount
Rtviewed, ready for corrections
Plan Check Deposit
Callcd Cont4Ct PcrsoA
Plan Chcck Balance
riany. Picked up
Construction
Plans resubmitted
.
i►Icchanlcal '
2" Review, resdyfor aorreWoasAssue
Electrical
Called Contact Person
Plumbing.
Plans picked up
Pians resubmitted
Grading
'— $tview, re4dy for correction e
3 o
Devetoger zmpaet Fee
.
Called Contact Person
'
A•.I.P.p.
bate of permit issue
.
Total rcrmlt Ftes
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