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05-2241 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 05-00002241 Property Address: '80965 BELLERIVE' APN: 775-35.0-018- - - Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 20000 Applicant: Architect or Engin lInr T<AcToK' PIA Tiht 4 4,Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- (CENSED CO TRACTOR'S DECLARATION I hereby affirm under periMty of perjury t t I ensed under provisions of hapt commencing with /Section 7 00) of i�' oli"ia7of the B s and Professionals Code, and m i�pJg�e and effect. ✓ License C ss: �� License No.: (((...VVV ✓✓✓ ��JJJ- _Date: Contractor. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury hat 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).: (_) 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 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 contractors) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C. for this reason I, 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: ,l Lender's Address: 1J LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/09/05 Owner: BRASCH 80-965 BELLERIVE LA QUINTA, CA 92253 Contractor: . FAMILY POOL CONSTRUCTION WCC: STATE FUND WC: 1344032-2005 03/01/06 CSLB: 658996 11/30/06 ----------------------------------------------- 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 umber are: Carrier C53-HIC Policy Numb - - - - - - - - - - - - - -- _ I certify that, in the performs c ' of thew or which this permit is issued, I shall not employ any person in any manner so t . e subject to the workers' compensation laws of California, and agree that, if 1 shou ome subject to the workers' compensation provisions of Section 7 of the La s I forth ith comply with those provisions. D e: Applicant: WARNIN FAILURE TO SECURE WORK RS' COM NSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000) IN ADDITION TO HE 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 applicatio b comes null and voi if work is not commenced within 180 days from date of issuance of su p rmit, or ce on of work.for 180 days will subject permit to cancellation. I certify that I have read this application and state that the a information is correct. I agree to comply with all city anF nces and state laws relating i di g onstruction, and hereby authorize representatives of thister upon the above-mentio prope o inspection purposes. Signature (Applicant or Age Application Number . . . . . 05-00002241 Permit . . . BLDG POOL PERMIT Additional desc . . Permit Fee 207.00 Plan Check Fee 134.55 Issue Date . . . . Valuation . . . . 20000 Expiration Date . . 12/06/05 Qty Unit Charge Per Extension BASE FEE 45.00 18.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 162.00 Permit . . . MECH POOL Additional desc . . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date Valuation . . . . 0 Expiration Date 12/06/05 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 12/06/05 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 7.50 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/06/05 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 LQPERAUT Application Number . . . . 05-00002241 ---------------------------------------------------------------------------- Special Notes and Comments BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary ----------------- Charged Paid -------------------- Credited Due Permit Fee Total 311.00 .00 -------------------- .00 311.00 Plan Check Total 159.80 .00 .00 159.80 Grand Total 470.80 .00 .00 470.80 LQPERMIT ",,6„ ids ion III i m I // _11�m - 80965 0e116Mi e 50 Faigle Pend 9-- 00 m (5 15"6'O5 eY a,,-rm It Yo,&& Construction P00h5 � jJQ5 FOUd Oin5 C7GO��G�-3G�5 1-ic. #658996