08-0662 (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:
08-00000662 $
57720 BALLYBUNION
762-360-005- -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
6000
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engin(
---------------41,
------------------------------
SED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of peIic sed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Pr ionaIs Code,and my License is in full force and effect.
LicenseClass: 53 censeNo.: 598681
Date:1 Contractor:OWNER-BUILDER DECLARATION
I hereby affirm under penalty of peexempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Bufessions 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 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.).
1 _ 1 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
r
c
Owner:
KIRIMA
57720 BALLYBUNION
LA QUINTA, CA 92253
Contractor:
AINSWORTH POOL CONSTR, ROBERT
40900 GLENMORE DRIVE
PALM DESERT, CA 92260
(760)200-2800
Lic. No.: 598681
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/25/08
-----------------------------------------------
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 CALIF INS Policy Number 460030110103
_ 1 certify that, in the perfor nce of the work for which this permit is issued, I shall not employ any
person in any manner so s to become subject to the workers' compensation laws of California,
and agree that, if I s oul become subject to the workers' compensation provisions of Section
� 0 of the Labor C de, I shall rthwith comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE O KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. IN ADDITIO 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 ofI
t, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state th thnformation is correct. I agree to comply with all
city and county ordinances and state laws relating t buitruc 'on, and hereby authorize representatives -
of thi co tyy t enter upon the above-mentioned pr parec urposes.
•Dater 1�u" Signature (Applicant or Agent):
Application Number . . . . . 08-00000662
Permit . . .
BLDG POOL PERMIT
Additional desc . .
' Permit Fee . . . .
81.00
Plan Check
Fee
52.65
Issue Date . . . .
Valuation
. . .
. 6000
Expiration Date
10/22/08
Qty Unit Charge
Per
Extension
- -
BASE
FEE -
45.00
4.00 9.0000
-----------------•-----------------------------------------------------------
THOU BLDG
2,001-25,000
36.00
Permit . . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . .
45.00
Plan Check
Fee
11.25
Issue Date
Valuation
. . .
. 0
Expiration Date
10/22/08
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 . . . .
24.00
Plan Check
Fee
6.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
10/22/08
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 6.0000
EA PLB
FIXTURE
6.00
1.00 3.0000
EA PLB'WATER
INST/ALT/REP
3.00
----------------------------------------------------------------------------
Special Notes and Comments
FOUNTAIN AND EQUIPMENT ONLY.
Fee summary Charged
Paid Credited
Due
---------------------------
Permit Fee Total
----------
150.00
----------
.00
----------
.00
150.00
Plan Check Total
69.90
.00
.00
69.90
Grand Total
219.90
.00
.00•
219.90
LQPERMIT
IL
Apr 22 08 02:55p 760 200-0040 P.1
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Bel
City of La Quinta
Building BE Safety Division
P.O. Box 1504, 78445 CaOe Tampico "
La Quitlta, CA 92253 - (760) 777-7012
-Building Permit Application and Tracking -Sheet
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Total Permit Fes