06-2826 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application. Number: 06-00002826 _
Property Adress: 81435 CARBONERAS
APN: 1 764-200-006-39 -316811-
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 62000
Applicant:
�el
Ti&t 4 4 0"
Architect or Engineer:
PSP
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 o Division 3 of the Business a Professional , and my License is in full force and effect.
License C ss: 53 /.�L�icennse No.: 518742
OWNER -BUILDER DECLARATION
I hereby affirm under penalty jury 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 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 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 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 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:
LQPERAIIT
Owner:
DUANE & TERRI JENSON
81435 CARBONERAS
LA QUINTA, CA 92253
V
Contractor: L
AMERICAN POOL CONSTRU TION
P.O. BOX 11996
PALM DESERT, CA 92255
(760)340-2588
Lic. No.: 518742
VOICE (760) 777-7012
FAX (760) 777;7011
INSPECTIONS (760) 777-7153
Date: 7/27/06
a�r440... l
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 FIIND Policy Number 0001188-2005
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 subject to the workers' compensation laws of California,
a agree that, if I should beco a subject to the workers' compensation provisions of Section
� Q 00 of the abor Code, I sh forthwith with those provisions.
R1ate:�✓l plican .
WARNING: AILURE TO SEC RE W ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CR INAL 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 cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to b ding construction, and hereby authorize representatives
of this c/ouDt to ter upon th .above -me ty for ins rposes.
A e: --�� at ure (Applicant gent):
Application Number . . . . . 06-00002826
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 468.50 Plan Check Fee 304.53
Issue Date . . . . Valuation . . . . 62000
Expiration Date 1/23/07 - -
Qty Unit Charge Per Extension
BASE FEE 414.50
12.00 4.5000 THOU BLDG 50,001-100,000 54.00
----------------------------------------------------------------------------
Permit . . . MECH POOL\
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration ate 1/23/07
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 d"esc . .
Permit Fee . . . . 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation 0
Expiration Date 1/23/07
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 1/23/07
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. ALARMS/BARRIERS SHALL BE IN
LQPERMIT
Application Number . . . . . 06-00002826
----------------------- ----------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 572.50 .00 .00 572.50
Plan Check Total 330.53 .00 .00 330.53
Grand Total 903.03 .00 .00 9Q3.03
LQPERMIT
07/27/2006 12:53 7606749438
AMERICAN POOL CONST PAGE 01/03
Bin #City
of La Quinta• y
Building 8t Safety Division "
Permit #P
-O. Box. 1504, 78-495 Calle Tampico
La Quinta, CA 92253 -.(760) 777-7012
Building
d'
Permit Application and Tracking Sheet
Project Address: .- 3 S
,��J - Owner's Name:
A. P. Number:
Address:
Legal Description:
.
i
City. ST, Zip: ZL.S
Contractor. ( r- Telephone:
,Address: led. �jlJ'�G aq <
Project Description:
City, ST, Zip:
t,•�/
Telephone T��— �S
.
State Lie. # :
City Lac. #:
Arch., Lngr.. Designer:
Address:
City, ST, Zip:
Telephone:
CoastMp6on Type: Occupaaay:
State Lic. #:
Projoct typo (circle one): New Add'n Altei Repair beano
Name of Contad Person:
Sq. Ft : #Stories: # Units"
Telephone # of Contact Person:
"Z Ps iwatcd Value of Project,
APPLICANT: DO NOT WNTE•BELOW THIS LINE
p Submittal Req'd
R-Wd TRACING. YERIVIxI' FEES
Plan Sets
Plan Check submitted ltc.m Amount
Structural Colts.
R viamd, ready for eorrtt tions Plan Check Deposit,
Truss Calm
Calltd Contact Ycnoo plan Check Balance
Energy Calci.
Ylaas.wched up Copsuvaioa
Flood plaln P13LA
Pians resubmitted Mechanical
Grading plan
26, Review, ready Ior'eorrecttonstuasttt Electrical
Subcontactor Ust
-Called Contact Verson Plumbing
Grant Decd
Plans picked up S.11I.I,
H.O.A. Approval
Plans resubmitted Grsdidg
IN HOUSE:-
Revicw, ready for correetioWiissue Developer Impact Fee
Planning Approval
Glued Contact Person
Pub. Wks. Appr
'Pitt of permit issue
School fees
Total Permit Fees