05-2568 (RPL)1;
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
C61\1 7 le -A C-1 a!
05 "00002568
S 7 3,2.5`PAS EODEL?liAGO
762-240-003-45 -300961-
POOL - COMMERCIAL
MEDIUM DENSITY RES
50000.
Tit�p 4 4 Qu&M
BUILDING & SAFETY DEPARTMENT
Architect or Engineer:
---------------------------------- - - - - - - - --- - - - - - - -
LICENSED C NTRACTOR'S DECLARATION
hereby affirm. under penalty, of perjury that ram lice � der.provisions of Chapter 9 (commencing with
Section 7000)zof Division 3 of theBusin�s�lrid- Pro sion s Code, andmy License is.in full and effect.
.License Clas :" CS ,C27, C29 License No.: 656128,
ate Z, J Contraaor:
OWN - ILDER DECLARATION '
.l hereby- affirm: under penalty of perjury that I am'exemptfrom the Contractor's State License Law for the
'following°reaso"n (Sec: 7031.5„Business and Professions Code: Any city or county ttiat requires a permit to
construct°:alter, improve; demolish, or repair any structure, prior to its issuance, also.requires iheapplicant for the
permit-tofile 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 M or she is exempt therefrom -and the basis for the'alleged exemption. Any violation of Section 4031-.5 by
any applicant fora permit subjects the applicant to a civil penalty of not.more than five hundred dollars ($500).:
(_ I 1 -as owner ;of the property, or.my-employees.with wages as their sole compensation, will do the work, and
-the structure is not intended,br offered for sale*(Sec.,7044, Business"and Professions Code.:. The.
Contractors` State:Lice05e.La'w 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'enployees,'provided that the
-improvements-are.:not intended or.offerecllor sale. If, however, the building,orimprovement is sold within '
.:one yearbf,completibn, 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,theproperty, am exclusivelycontracting-with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors`State License Law does not apply -town 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
=RMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
PUERTA AZUL PARTNERS
17700 SW UPPER BOONES FERRY RD
SUITE 100
PORTLAND, OR 97224
Contractor:
CALIFORNIA POOLS & SPAS
P.O. BOX 1280 .
COACHELLA, CA 92236
(760)398-9222 -
LiC. 140::•656128
Date: 6/23/05
- WORKER'&.COMPENSATION DECLARATION -
'I hereby affirm under penalty of perjury one of. the following declarations:
I.have and willmaintain a certificate of bonsent•to self -insure for workers' compensation, as provided
for bySection3700 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 ofthe Labor
Code,"foc,theperformance of the work for which this permit is issued. My workers' compensation
insuiance carrier• and. policy number are: -
Carrier SEABRIGHT• INS,r. Policy Number BB1050510
I certifythat; in the performance oft - viol' which this permit is issued, I shall not employ any
'person in any manner so as to bec a subje to the workers'compensation laws of California,
• and agree that, if I should become b ct t the workers' compensation provisions,of Section
/-,/�/.j 37700000 of. the Labor C e I shall' o wit ompl ose provisions.
att0" e: `o/(YJApplicant
WARNING: 'FAILURE TO SECURE` ORKERS' COMPENSATION COVERAGEIS 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.theDirector 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 Ouinta, 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 f work is not commenced .
within 180 days from date of issuance of such permit, or ce tion of rk for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above informati n i orre . I agree to comply with all
city and county ordinances and state laws relating to buil ' g construct' n, and r y authorize representatives
of thi coun to'ente upon the above-mentioned prope f inspec ' n p po
te: 49Pture (Applicant or Agent).
Application Number .
. . . . 05-00002568
Permit
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check
Fee
6.50
Issue Date
Valuation
. . .
. 0
Expiration Date
12/20/05.
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 '11.0000.EA
MECH FURNACE >100K
11.00
:Permit
ELEC -MISCELLANEOUS'.
Additional 'desc .
Permit_ Fee
.33.50° Plan Check
Fee
8.38
Issue .Date . . . ...
Valuation
0
Expiration Date
12/20/05
Qty Unit Charge
Per
-,Extension
BASE .•FEE ..15.:
00-
1.00 18.5000
--------------------
EA ELEC SVC <=600V/<=200A
18:50
Permit..,
PLUMBING.
Additional desc
Permit- ','Fee.
45.0.0 Plan Check
Fees..'
11..25
Issue Date
Valuation`
0
Expiratibri,..Date°.
12/20/05 "
Qty Unit Charge
-Per'
Extension
BASE FEE'
15.00
4.00 6.0000
EA, PLB FIXTURE
:24100
1.00 '3.0000
EA PLB" WATER'-INST/ALT/-.REP
.31:00
1.00 3•.0000
EA .. -PLB' GAS1�PIPE 1`-4: OUTLETS ..
'T. 00
Permit
BLDG POOL PERMIT
Additional 'desc...
Permit Fee.
414:.50 Plan Check
Fee
269.43
Issue :Date
Valuation
. . .
50000
Expiration Date
12/20%05
Qty Unit Charge
Per
Extension
BASE FEE
252.00
25.00 6.5000
THOU BLDG 25,001-50,000
162.50
Special Notes 'and. Comments
COMMERCIAL POOL & SPA
ONLY.
LQPERMIT
LQPERMIT
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