06-2758 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht aFa (P 4"
Application Number: 06-00002758
Property Address: 81485 CAR13ONERAS
APN: ' 764-200-006.-44 -316811-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
FISHER
81-485 CARBO NERAS
LA QUINTA, CA 92253
Contractor:
CALIFORNIA POOLS & S
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/20/06
JUL 212006
OF LA
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business z d Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C8 C27 C29 License No.: 656128
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
�y
—eraye: ll�`Germactor:
_ 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
WNER-BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier SEABRIGHT Policy Number BB1060510
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to'the provisions of the Contractor's State
and agree that, if I should b ome subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I s a forthwith comply with those provisions.
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).:
D plicant:
l _ 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
WARNING: FAILURE TO SECURE WORKER 'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditibns and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
( 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend,, indemnify and hold harmless the City
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
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 a ve information is correct. I agree to comply with all
city and county ordinances and state laws relating to building onstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned pro 'section purposes.
+,� tig5 - at), tyLe.(A'pplicant or Agent):
Application Number . . . . . 06-00002758
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 72.00
Plan Check Fee
46.80
Issue Date . . . .
Valuation
5000
Expiration Date 1/16/07
Qty Unit Charge Per
Extension
BASE
FEE
45.00
3.00 9.0000 THOU BLDG
----------------------------------------------------------------------------
2,001-25,000
27.00
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 18.00
Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 1/16/07
Qty Unit Charge Per
Extension
BASE
FEE
15.00
4.00 .7500 PER ELEC
DEVICE/FIXTURE 1ST 20
3.00
--------------------------------------------
--------------------------------
Special Notes and Comments
BBQ PER APPROVED PLAN
Fee summary Charged
--------------------
Paid Credited
--------------------
Due
-----------------
Permit Fee Total 90.00
.00 .00
90.00
Plan Check Total 51.30
.00 .00
51.30
Grand Total 141.30
.00 .00
141.30
LQPEPNIIT
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P O Box,150`4,,78 495'Ca11e Tampico
La Quetta, CA}92253 (760)-7774-
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