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06-1354 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 106-00001354 52360 AVENIDA MONTEZUMA 773-241-034- - POOL - RESIDENTIAL COVE RESIDENTIAL 15000 Architect or Engi A/C,) TdAf Q�� BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ®Owner: O SHIVELY JEFFERY J 52810 AVENIDA MONTEZUMA IAPR 1 �720LA.QUINTA, CA 92253 LICENSED CONTRACTOR'S DECLARATION 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 Business and Professionals Code, and my License is in full force and effect. License Class: C53 License No.: 867946 Date. _ ZOO Contractor: OWNER -BUILDER DEC TION I hereby affirm under penalty of p ury that I am exempt from theConvac 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 _ 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 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 am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY .1 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 Contractor: DESERT POOLS CONSTRUCTION 83370 VECINO WAY INDIO, CA 92201 (760)578-6281 Lic. No.: 867946 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/11/06 WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: 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 Y I certify that, in the performance of the work for which this permit is issued, I shall not employ any 7� 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 Lab/or Cod I shall forthwith comply with those provisions. aD te: �Z-'O.ApplicaRf WARNING: FAILURE TO SEC U EW KERS' COMPENSA NCO RAG UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO NAL PENALTIES AND CIVIL FI ES UP TO E HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPEN TION, DAM GES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY' EES. - 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 county ordinances and state laws relating to building construction, and hereby authorize representatives oftho county to enter upon the above-mentionedperty for inspection purposes. battee: y Signature (Applicant or Ager ): Application Number . . . 06-00001354 Permit . . . BLDG POOL PERMIT Additional desc " Permit Fee . . 162.00 Plan Check Fee 105.30 Issue Date . . . . Valuation . . . . 15000 Expiration Date 10/08/06 Qty Unit Charge Per Extension BASE FEE 45.00 13.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 117.00 Permit . . . MECH POOL Additional desc . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 10/08/06 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 10/08/06 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 10/08/06 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 ---------------------------------=------------------------------------------ Special Notes and Comments POOL & SPA ONLY. ALARMS/BARRIERS SHALL LQPERMTT Application Number . . 06-00001354 Special Notes and Comments BE IN PLACE PRIOR TO PRE -PLASTER - INSPECTION. EQUIPMENT ENCLOSURE NOT INLCUDED IN PERMIT. Fee summary ----------------- Charged Paid -------------------- Credited -------------------- Due Permit Fee Total 266.00 .00 .00 266.00 Plan Check Total 131.30 .00 .00 131.30 Grand.Total 397.30 .00 .00 397.30 LQPERMIT 1 Bin # ' City of La Quinta Building U Safety Division P.O. Box 1504,78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Perrnit # 13S Project Address: Men- rA&Owner's Name: �'.'�' A. P. Number: Address: S Legal Description:. Contractor: �: City, ST, Zip: �- Telephone: ' Address: Project Description: -• A. City, ST, Zip: 1. LA QZ?ZO l 1 Telephone:�� City Lic. #: State Lic. # :867 Arch., Engr., Designer:. Address: City, ST, Zip: Telephone: ; State Lic. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle.one): New Add'n Alter Repair Demo Sq. Ft.: al�� # Stories: # Units: Telephone # of Contact Person: 6 R1 Estimated Value of Project: APPLICANT: .4000 DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACMG nl. PERMIT FEES ,Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called -Contact Person Plan* Check Balance Energy Calcs. Plans picked up Construction' Flood plain plan Plans resubmitted Mechanical Grading, plan 2"" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7r° Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees RECEIPT City of La Quinta, 78-495 Calle Tampico, P.O. Box 1504, La Quinta, CA 92247 DATE 3 20`d�" 4108 __—RECEIVED FROM Aff ADDRESS DOLLARS $ FOR ���✓' ACCOU HO PAID - AMT.OF CASH ACCOU AMT. PAID BALANCE MONEY I BY DUE ORDER .. ******fir****tt** **+k ir�r^kffkrtk*1t+krFfk*yrirrF*kir#irir.F�r PROOF OF WORKER, S COMPENSATION INSURANCE & COPY OF STATE CONTRACTORS LICENSE POCKET CARD IS'REQUIRED PRIOR TO ISSUANCE 1. Business Name: k�UOL_C e--nK)�,jj-td hf (Z> Business Address:?`-d�'��,y City/State: VBG Zip: 2. Mailing Address: * FMTI 6_ City/State: Zip:, 3. Business Phone: O 4. Owned By: CORP_ PARTNERSHIP_ INDIVIDUAL 5. If Corporation or Partnership, Tax I.D. #:. 6. Name of Owner or Officers and Title: . W , 1 a� s 7. Vehicle. License Number 769' Permit Number (Finance Dept'. Only) 8. Type of Contractor; Bl�/ B. Classification: r 5� C. State. License Number 8f2_7q,(/( A or B License Classification $100. ai or $50.00 Semi -Annual C License Classification $ 50.00 Per Year o $25.00 Semi -Annual HEREBY CERTIFY that all the information supplied by me is correct and any licenses required by the County. State or Federal Government have been issued to me and are in full force and effect. BUSINESS LICENSE DIVISION P.O: BOX 11504- La 504-La Quinta, CA 92247-1504 S�g•1 ��'�Ga CITY OF LA QUINTA SUB -CONTRACTOR LIST ThOiB fADDRhESll Sbe��s. d th'b ith hBildiIPERMioIT CNUdMBElRl iO BUILDER Vb,6� �o Z& Corys/Vk list or thdir 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. CIassi ca ion Contractorr e.;ContrtrTrade .. :. W res LcensacosLcense. CerStaty Company Name Classification (e.g. A. B, C-8) License Number (xxxxxx) Exp. Date (xxlxx/xx) Carrier Name (e.geState Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number . (xxxx) Exp. Date (xxlxx/xx) EARTHWORK IC=i 2) ..,, U Va r rb ��0 b130I04 00I5 CONCRETE (C-8) ::. FRAMING STRUCT."STEEL (C-51) V MASONRY (C-29) .. PLUMBING (C-361 yv�2 5 '7iQ LAM, PLASTER (C�35) 1 b (U ►l! l n DRYWALL (C-9). HVAC: ELECTRICAL. (C-101' .SHEET METAL'(S43) FLOORING (C :151% GLAZING (C; 1 .7 INSULATION (C-2) :' SEWAGE Dim. (6-42) . PAINTING (C=33) CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) ' LANDSCAPING (C=27.) POOL (C-53) C;;; - %O`