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05-5415 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tiht 4 44ur«rr, Application Number:Co5-000054.15 Property Address: 7.96 CORTE DEL VISTA APN: 609-380-997-21 -293233- Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 28000 Applicant: Architect or E BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------- --------- LICENSED CON ACTOR'S DECLARATION 1 hereby affirm under penalty of perjury th t 1 am Iic rise _der provisions of Chapter 9 (commencing with Section 7000) of Division 3 of fke Businea d Pro ssi als Code, and my License is in full force and effect. License CI s: 53 License No.: 841981 r t0 _GomFaictc-�- --+� 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 70001 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 _ 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 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 (t 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: ARRIAGA 79-640 CORTE DEL VISTA LA QUINTA, CA LA QUINTA, CA 92253 Contractor: A & R COMPLETE POOL SERVICE P.O. BOX 103 LA QUINTA, CA 92247 (760)772-0752 Lic. No.: 841981 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/12/05 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 Xissued. 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 YOUNGEILOND INS Policy Number 229003025105 _ I certify that, in the performance of the wor or which this permit is issued, I shall not employ any person in anytor nner sS91 as to becomes ject to the workers' compensation laws of California, and agree that I sho� biome Tbje o the workers' compensation provisions of Section P700 of the L Co I all forfhwitfi comply with those provisions. 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 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 cessati;oork for 0 days will subject permit to cancellation. I certify that I have read this applicationand state that the ab a information ist.. I a ee to comply with all city and county ordinances and state laws relating to ilding on ruction, y aut rize representatives of th' cou y to e r upon the above-mentioned r erty f in coon p Application Number . . . . . 05-00005415 Gk LQPERMIT 'Permit . . . BLDG POOL PERMIT Additional 'desc . . Permit Fee . . . . 271.50 Plan Check Fee 176.48 Issue Date . . . . Valuation . . . 27888 Expiration Date 6/10/06 Qty Unit Charge Per Extension BASE FEE 252.00 3.00 6.5000 ---------------------------------------------------------------------------- THOU BLDG 25,001-50,000 19.50 Permit . . . MECH POOL Additional desc . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date Valuation . . . . 0 Expiration Date 6/10/06 Qty Unit.Charge Per Extension BASE FEE 15.00 { 1.00 11.0000 ------------------------- =---------------------------------------------------- EA MECH FURNACE >100K 11.00' PermitELEC POOL PERMIT -RES �^ { Additional desc . Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date . . . . Valuation 0 Expiration Date 6/10/06 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 8.25 , Issue Date Valuation . . . . 0 Expiration Date 6/10/06 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 Permit . . . . . . WALL/FENCE PERMIT l Gk LQPERMIT Application Number . . . . . 05-00005415 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date Valuation . . . . 112 Expiration Date*. 6/10/06 Qty Unit Charge Per Extension BASE FEE L 15.00 ---------------------------------------------------------------------- Special Notes and Comments ----- POOL & SPA. 7 L.F. 4- EQUIPMENT WALL, ORCO SYSTEM. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. _ Fee summary Charged Paid Credited Due ----------------- ---------- ---------- f Permit Fee Total 390.50 ---------- .00 ---------- .00 390.50 Plan Check Total 202.48 .00 .00 202.48 Grand Total 592.98 .00 .00 592.98 0, G+ LQPERMIT 9 Bin # City of La Quinta Building 8z Safety Division P.O. -Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 77777012 Building Permit Application and Tracking Sheet Permit # 0S — Project Address: r19 6,qQ Q kf Owner's Name: jOr gg', p C A. P. Number: Address: 2 Legal Description: City, ST, Zip: I Li Q U.1 [�fi Contractor: A -D ft %4- r%, &Vnwe,�-,Ppols, Telephone*. Address: P.O - 6Z)K 1011a) Project Description: City, ST, Zip: /A I (CA ('A -PQQ1 (a-4S4)tA__-1 . N Telephone: '70 77.2-D-1 �5 Ll c5h HO *J 42 State Lic. # 0o 14 1 c?S City Lic Arch., Engr., Designer: Address: �4 City, ST, Zip: 41 (A) i De- Y ( Construction Type: 4iccupancy: Telephone: State Lic. #: Name of Contact Person:#Stories: I Project type (circle one): 61-7) Add'n Alter Repair Demo Sq. Ft.: L ISD Units: Telephone # of Contact Person:11-_737S09 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec,'d TRACKING PERMIT FEES Plan Sets Plan Check submitted �L Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Energy 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. R.O.A. Approval Plans resubmitted Grading IN HOUSE- Review, 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 T0taI Permit Fees 62 94W fZ Ut5 1TY` OF LA QUINTA SUB -CONTRA TOR .IS C�D T �p Jai ADDRESS LD RERMIT NUMBER � -S415. OWNER l.t -fr�r BUILDER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees. are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance OT uuiiaing permit. t -or eacn applicable traae, all information requestea below must be completes by applicant."Un t -Ile" is not an acceptable response. :::...:..::. :::.:...::::: ::::..::.:.:::.....:......::.:::::.:.:...:::..:.:.:.::::.:......:::::::.:::::. ............. :5`i:� �>:»»:.::::::.. ..:. .::. Qs t �.;"r'''`��Z:cie::��;�a ::,1.;G�.i�i�::.1>:... ... .... ...,.. 'sE::n'_C�:. �''s':i..::.12'i5a:`t�t;i:_:..................,.. _..._ _ :._ _ ...i'G•:r:.i�R':'c::'ecc�il �:ro`r�iii�i%ii1:::;: Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. (xx/x S I ioI 7 3� b� S fy-1--{� �u AJb 6l0