SOTB (07-2795)-:a
P.O. BOX 1504
78-495 CALLE TAMPICO
TLA QUINTA, CALIFORNIA 92253
T-v4t 4.4 Q"
Application Number:
07-00002795
= Property Address:
79030 MISSION DR W
APN:
649-460-003- - -
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1000
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
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 BusineaaionasrofesslCode, amnd License is in full force and effect.
License Class: B C53 Li se N 85102
e�ate: / �Contractorr�
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 ($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.).
I _ 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 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:
LQPERI%IIT
Owner:
LATEK
79-030 MISSION DR. W
LA QUINTA, CA 92253
Contractor:
CALIFORNIA POOLS & SP
3106 E. GARVEY AVENUE
WEST COVINA, CA 91791
(760)771-6141
Lic. No.: 185102
VOICE (760) 777-7012
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Date: 10/22/07
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.
4 1 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 ARCH INS CO Policy Number ZAWCI9090400
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 a to become subject to the workers' compensation laws of California,
and agree that, if I shou b come s bject to the workers' compensation provisions of Section
% 3700 of the Labor Co , I hall f w' c pl i those provisions.
bate:. �/' pplicand
WARNING: FAILURE TO SECURE WORKERS' 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 haimless 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 ve information is correct. I agree to.comply with all
city and county ordinances and state laws relating to bui ing onst ruction, and hereb a thorize representatives
of this county to enter upon the above-mentioned prop y f r inspe ion pu oses.
[/
Date: rl l ignature (Applicant or Agent
LQPER-kIIT
Application Number 07-00002795
Permit . ... BUILDING PERMIT
Additional desc .
Permit Fee . . . . 25.00
Plan Check
Fee
16.25
Issue Date . . . .
Valuation
. . .
. 1000
Expiration Date 4/19/08_
Qty Unit Charge Per
Extension
BASE
FEE
15.00
5.00 2.0000 HND BLDG
501-2,000
10.00
----------------------------------------------------------------------------
Special Notes and Comments
FIREPIT PER APPROVED PLANS
Fee summary Charged
-------------------------------------
Paid Credited
----------
-------
Due
Permit Fee Fee Total 25.00
.00
.00
25.00
Plan Check Total 16.25
.00
.00
16.25
Grand Total 41.25
.00
.00
41.25
LQPER-kIIT
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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
Permit #
%
Project Address: -7 O AJ
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: Pew 15-
Address: 7 /P
Project Description:
City, ST, Zip:
Tele hone: � Yr`
P J--(�
(�
State Lic. #
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
�I�li i�' l"Y �� ��
Construction Type: Occupancy:
Project type (circle one . New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: % ' 72 2-6
Estimated Value of Project: C
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'd
TRACKING _
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed., ready for corrections
Plan Check Deposit
Truss Cates.
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
I1V HOUSE:-
7rd Review, ready for corrections/issue
Developer Impact Fee
Plan ngal
Called Contact Person
A.I.P.P.
Pub Wpp i-
Qate of permit issue
Sc ool FeesA W7
Sq
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FORC
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91�f
pT
0
CTS
Total Permit Fees