05-3792 (RPL)P.O. BOX 1504 4
• ���1NIN
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: C05=OQO.03792; Owner:
Property Address: 81555 CARBONERAS CORAL OPTION I
APN: 764-200-006-51 -316811- 79295 RANCHO LA QUINTA DR
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 19000
Contractor:
Applicant: Architect or Engineer: CALIFORNIA POOLS & SPAS
WCC: SEABRIGHT INS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and m License is in fullri9 ce and effect.
License Class: �/ License No.: T � lel
/ate:W -I Contract r: /
r
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 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 1$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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) 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
WC: BB1050510
CSLB: 656128
VOICE (760) 777-7042
FAX (760) .777-7011
INSPECTIONS (760) 777-7153
01/01/06
10/31/06
Date- 8/25/05
D_
SAIj /
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 C8 C27 C29 C53 Policy Number - - - - - - - - - - - - - --
_ 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,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Co e, I shall forthwith comply with those provisions.
CCu � r
ate$
: '-0 1 Applicant:
WARNING: FAILURE TO SECURE WOR ERS' 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 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 building construction, and hereby authorize representatives
of thi county to enter upon the above-mentioned pr pe for inspection purposes.
Date: Signature (Applicant or Age
Application Number . . . . 05 -00003792 -
Permit .
. . BLDG POOL PERMIT
Extension
Additional desc
.
1.00 11.0000
------------------------7---------------------------------------------------
EA MECH FURNACE >100K
Permit Fee . .
. . 198.00
Plan Check Fee
128.70
Issue Date . .
. .
Valuation
19000.
Expiration Date
2/21/06.
Issue Date . . .
Valuation . . . .
Qty Unit
Charge Per
2/21/06
Extension
Qty Unit Charge
BASE FEE
Extension
45.00
17.00
----------------------------------------------------------------------------
9.0000 THOU BLDG 2,001-25,000
1.00 30.0000
---------------------------------------------7------------7-----------------
153..00
Permit .
. . MECH POOL
PLUMBING
Additional desc
.
Permit Fee . . . .
Permit Fee . .
. . 26.00
Plan Check Fee
6.50
Issue Date . .
. .
Valuation . . .
. 0
Expiration Date . . 2/21/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
------------------------7---------------------------------------------------
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 .
2/21/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
---------------------------------------------7------------7-----------------
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
2/21/06
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
-----------------------------7---------------------------------'-------------
Special Notes and Comments
POOL, SPA & WATERFEATURE.
LQPERMIT
M
Application Number . . . . . 05-00003792
----------------------------------------------------------------------------
Special Notes and Comments
ALARMS/BARRIERS SHALL BE IN PLACE PRIOR
TO PRE -PLASTER INSPECTION. EQUIPMENT
ENCLOSURE NOT INCLUDED IN PERMIT.
Fee summary Charged
----------------- ----------
Permit Fee.Total 302.00
Plan Check Total 153.95
Grand Total 455.95
LQPERMIT
Paid Credited Due
---------- ---------- ----------
.00 .00 302.00
.00 .00 153.95
.00 .00 455.95
Bin. #f
City of La Quinta
Building &r Safety Division
P.O. Box l SO4, 78-495 Calle Tampico
-La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
05- - 3 9�zk
Project Address: �l —�j �� o
Owner's Name:c,,,
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:C CiDols s�
Address:
Telephone: ;:::.>:::•:
Project Description:
City, ST, Zip: Coca CA d 2-9 3
tot
-`}i.:Yii:?Yi i?i}),:}>i?;'r^•:i: �ij4•v};?.•• -t,
Telephone:
State Lic. # City Lic. #.
Arch., Engr., Designer:
Address:
City., ST, Zip:
'??•tij�:i:;ti?}jJKk}:j:.}:Y; r:{:ti,:�':}::i}i�•n•:. �}}•:•:i.:{.
Telephone:
State Lic. #: :;;;, >.,;:,;;;; ,.s;
Name of Contact Person: DAA) j-A�T
Construction Type: Occupancy:
Project type (circle one): e Add'n Alter Repair Demo
Sq. Ft.: # Stories:77 # Units:
Telephone # of Contact Person: S',/j Z
Estimated Value of Project:' l9 0.(!:, Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
IN44-
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan. Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for corrections/issue
Electrical '
Subcontactor List
Called ContactPerson
Plumbing
Grant Deed
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
.IN HOUSE:-.
'"' Review, ready for corrections/issue
Developer Impact Fee .
Planning Approval
Called Contact Person
A.1.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Pees
y
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__. . (e1 Ffli POOL IMMEDIATELY AFTER PLASTER. (FI110W INSTRUCTIONS--DO NOT LISfi RU@I3E3E Hi] ]
• ' i F r (7) TAKE NOTICE THAT THIS ORA NO IS THE SOLE PROPERTY OF C#WCRN1A POOLS AND THAT ANY
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I F I -- �' OWNER APPROWS PLAN, POLL, AND ECUIPIAEM LffATIOI�S AND HAS READ THE R£5PONSERL flES AND NOTICES ABOVE.I - — -— TX- A R- —
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PjEABNI:Y/PLAS '"7-jIce,..:12:-'2'61'T E.V.--(_. 8.5-1"1;11,!-)A-Ji L-Q1,:„.1jA4:0-1, ii
,� SIGNATURE
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[i PRE-PEBBLE DRAIf�+ E NOTE' Drainage and irrigation for planters and poles, by
others, unless otherwise noted,
-
j; —