09-0775 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: L09�00000775
T4'1t 4 4 Q"
Property Address: 57790 BLACK DIAMOND
APN: 762-370-029- - -
Application description: SPECIAL INSPECTION
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 0
Applicant Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed oder provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busine s and ofessio als C e, and my License is in full force and effect.
License Class- B C53 Lic eNo.: 750334
Date: r Contractor:
OWNER -BUILD R DECLARATION
I hereby affirm under penalty of perju that I am exempt fro the Contractor's State license Law for the
following reason (Sec. 7031.5, Busi ss 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 155001.:
(_ 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 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.).
1 — I 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
Owner:
INDY MAC PROPERTIES
100 FARMERS CORCLE S E 400
AUSTIN, TX 78738
(512)467-1537
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/17/09
�v �f
i
I
Contractor:
SPLASH SPAS & POOLI.
2780 DOVETAIL STRE T C1" OFhk
SAN MARCOS, CA 920 FdIV
(760)736-0067
Lic. No.: 750334
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 189136508
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 subj t to the workers' compensation laws of California,
and agree that, if I shou bye subject the rkers' compensation provisions of Section
700 of the Labor Co , I sh forthwith omp ith those provisions.
Dat Applicant:
WARNING: AILURE TO SECURE ORKERS' COMPENSAT N COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI INAL PENALTIES AND VIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDI ION 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 ands
tate that the ab live in motion is rrect. agree to comply with all
city and county ordinances and state laws relating to buildi con ction, an ereb thorize representatives
of this coup y to nter upon the above-mentioned property ori ection p ses.
Date Signature (Applicant or Agent): 44
- z
Application Number
. . . . . 09-00000775
Permit . .
. SPECIAL INSPECTION
Additional desc .
Permit Fee
100.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 0
Expiration Date
1/13/10
Qty Unit Charge
Per'
Extension
BASE
FEE
100.00
----------------------------------------------------------------------------
Special Notes and
Comments
SPECIAL INSPECTION
/ ELECTRICAL
INTEGRITY.
Fee summary
-----------------
Charged
--------------------
Paid Credited
----------
----------
Due
Permit Fee Total
100.00
.00
.00
100.00
Plan Check Total
.00
.00
.00
.00
Grand Total
100.00
.00
.00
100.00
c
LQPERMIT
I
Bin #
Qty of La Quin
-Building 8z 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: 57-7VO eidck VI'A wnmr,>
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
Address:o
. 12y.L—EA 16' L AM WAAC-S
Project Description:
City, ST, Zip: 7 1K
_L: �f
Telephone: 7LO Z14 -ootl, -7
State Lic. #:
City Lic.
Arch., Engr., Designer:
Address:
City., ST, Zip:
. ........
Telephone:
M
State Lic. 11.....} "`'"''
Construction type: Occupancy:
Pro'ect type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: 77
_#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE. BELOW THIS LINE
Submittal
Req)d
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural CaIcs.
Reviewed, ready for corrections Plan Check Deposit
Truss Cales.
Called Contact Person flan Check Balance.
Title 24 Cales.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2-d Review, ready for corrections/issue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up. S.M.I.
ilb.A. Approval
Plans resubmitted Grading
IN HOOSE:-
Reylew,ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees