RPL (06-2554)>� n
PvO. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
06-00002554
79604 `MISSION `DR E
649-650-008- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
27500
Tiht 4XP4"
Architect or Engineer:
P 14
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
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 Lic nseNo.: 238947
1,
OWNER -BUILDER DECLARATION '
I hereby affirm under pe 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 ($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 _ 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_) 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:
LQPERAIIT
Owner:
BOB PETERSON
79604 MISSION DRIVE EAST
LA QUINTA, CA 92253
Contractor:
MASTER POOLS AND SPAS
73555 HIGHWAY 111
PALM DESERT, CA 92260
(760)346-6115
Lic. No.: 238947
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/28/06
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.
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 0014573-2006
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 he Labor Code, I shakforthwith comply with those provisions.
t aT rP1/1 *1nv
WARNING: FAILURE TO SECYPIF WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER T 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of thjs-county to enter up n the above-mentioned propert for inspection pur ses.
Dater i nature (Applicant or Age
LQPERMIT
Application Number .
. . 06-00002554
Permit`
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee
45.00 Plan Check Fee
11.25
Issue•Date
Valuation .
. 0
Expiration Date
12/25/06
Qty Unit Charge
Per -
Extension
BASE FEE
15.00
1.00 30.0000
EA ELEC PRIVATE SWIMMING POOL'
30.00
Permit
BLDG POOL PERMIT
Additional desc .
Permit Fee
271:50 Plan Check Fee
176.48
Issue Date . . .
Valuation
27500
Expiration Date
12/25/C6
Qty Unit Charge
Per
Extension
BASE FEE
252.00
3.00 6.5000
THOU BLDG 25,001-50,000
19.50
Permit
PLUMBING
Additional desc .
Permit Fee
33.00 Plan Check Fee
8.25
Issue Date . . .
Valuation . . .
. 0
Expiration Date
12/25/06
Qty Unit Charge
Per s
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.ALARMS/BARRIERS
SHALL BE IN PLACE
AT PRE -PLASTER INSPECTION.
EQUIPMENT
ENCLOSURE NOT INCLUDED
Fee summary Charged
Paid Credited
Due
Permit Fee Total
349.50 .00 .00
349.50
Plan Check Total
195.98 .00 00
195.98
Grand Total
545.48 .00 .00
545.48
6-28-06; 6=17PM;Master Pools ;7607765889.
2
1
A
A RE—INSPECTION FEE OF $30 CITY OF L.A.
n WILL BE CHARGED IF THE APPROVED
BUILDING & SAFETY'DEPT,
PLANS AND 10B CARD ARE N AP NOT ON FOR APPROVED
THE SITE FOR A SCHEDULED CONSTRUCTION 8Ha
INSPECTION:
�q �'IOb BY o S Z .
NO EXCEPTIONS!0.
" MASM P001S&SPAS'o . .
Designers 8 Builders Since 1968
73M Ken.ar 111 TJ.m.nn Shopphe center
• - Pain M-1. C bb.l..2200
Z . (700Atde911
S ob Lkenn /Cd2]E.I?
Q BOB PETERSON 4 JACQUIE TOY R A
— $ 71-604 MISSION. DRIVE EAST
C
LA OUINTA, A. -12253
RANCHO LA QUINTA
r
X
2
1
A
A RE—INSPECTION FEE OF $30 CITY OF L.A.
n WILL BE CHARGED IF THE APPROVED
BUILDING & SAFETY'DEPT,
PLANS AND 10B CARD ARE N AP NOT ON FOR APPROVED
THE SITE FOR A SCHEDULED CONSTRUCTION 8Ha
INSPECTION:
�q �'IOb BY o S Z .
NO EXCEPTIONS!0.
" MASM P001S&SPAS'o . .
Designers 8 Builders Since 1968
73M Ken.ar 111 TJ.m.nn Shopphe center
• - Pain M-1. C bb.l..2200
Z . (700Atde911
S ob Lkenn /Cd2]E.I?
Q BOB PETERSON 4 JACQUIE TOY R A
— $ 71-604 MISSION. DRIVE EAST
C
LA OUINTA, A. -12253
RANCHO LA QUINTA
i
6-28-06; 6:17PM;Master Pools
;7607765889 # ,/'
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City of u nta ...
LaQt
:{:ti £`a�•k4'i'n:#a lin
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'Building 8L Safety Division )
is vdk"`r
P.O. Box 1 504 ... ..
-78-49S Calle Tampico
.<'
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i.a Quinta, CA 9$253
t":<:��$:< :><--:>
Permit
Bulldmg Application and Tracking Sheet
Project Address: vE "57-
Owner's Name: Pfz T 2��
A, P. Number.
'Address:
Legal Desch tion:
City,ST, Zip:
Contractor:_Sats
Telephone: »`>%•`'>r.><:<><?9rc6{a
Address: a3.. ' S
Project Description:
C4.ST7ap:
ep �'1 . 1t1 - �
Tel hon
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�v.::.,r):#a`,roeX�:2..'$'.`�;n.•9ti::ti:::!�£}:a�,�C,�''--
State Lit -it: Z
City Lic. #:
-
Arch.. Engr.. Designer.
:....:.._
Address:.
City. ST. -Zip_ __...
Telephone: i}4$':+J'����?�t4.,D3'(:'2i �i\{;#Fv:i'•}�\.\
}}f��"`;r!:? t.r -a{`•' ' Construction Type: y✓ occupancy:
%Y�,:�:•;gx:22;:•.�e�r;.3):.3•t.,,.V�Y�a`i:;:c::
�Srr n:S:r3$-' .t 'r •"»rc3�
-` }}State Lit. #: nJ ProJect type circle one): Add'n Alter Repair Demo
Name of Contact Person: �'� ,� �' • . f'E{ S Sq. Ft.: # Stories: # Units:
��•� s'.
Telephone # of Contact Person: �� �' S7 Estimated Value of Project: -2-7 �d� -. .>,,,•,.�,..w~._._
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