05-1976 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number,:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
05-00001976
81699 CHARISMATIC WY
767-200-999-54 -312021-
POOL - RESIDENTIAL
LOW DENSITY.RESIDENTIAL
20000
T4ht 4 4 Qu&z
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-70.12
FAX (760) 777-7011
INSPECTIONS (760) 777-7153-
Owner:
77-7153
Owner:
DESERT CHEYENNE., INC.
78401 HIGHWAY 111, SUITE G
LA QUINTA, CA 92253
(760)777-9920
Contractor:
MCIN_TYRE POOLS & SPAS., INC.
WCC: STATE FUND
WC: 1769111 01/01/0.6
CSLB.: 614611 09../30/05
Date: 5/23/0.5
-------------------------------------------------
.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 penahy.of perjury one of the following declarations:
ction 7000) of ivisi the Business and Professionals Code,.e y i n I and effect:
License Class: L7 G" - License' /
_ I have and will maintain a certificate of consent to seH4nsure for workers!, compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
-
Z�- :RsC-thacror j e S J/gy
issued. -
p 1 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
following reason (Sec. 7031.6, Business and Professions Code: Any city or county that requires a permit to
_ I conifythat, in the performance of thwwork for which this permit Is'issued, 'I shall, not;employ, any
construct, cher, improve, demolish, or repair any structure, prior to its issuance, also requires the applicent:for the
person in any manner so as to become subject to'the workers' compensation laws of California,
permit to file s signed statement thaviie or she is licensed pursuant to the proyisiorwof the Contractor's State
and agree that; if 1 should become subject to the worker `c mp motion provisions of Section
License Law (Chapter 9 (commencing with Section 7001)) of"Division 3 cf the Business arta Professions Code) or
3700 of the Labor Code •shall fort hwi omply with a pro '' ons.
that he or she is exempt therefrorim 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 ($600).:
--2-OSApplicafrc:-
(_ 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 WORK SCOMPENSAT N.COVERAGEIS UNLAWFUL, AND SHALL
Contractors' State1icense Law does not:apply to an•ownerof 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 (4100,000). 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 3706,01"THE LABOR CODE, INTEREST, AND ATTORNEY'S, FEES.
one year of completion, the owner -builder will have the burden of°proving that he or.shedid not build or
improve for the purposeof sale.).
APPLICANT ACKNOWLEDGEMENT
(_ ! 1, as owner ofthe 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 Lew does not apply to•an owner of
conditions 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
pursuani to the Contractors' State License Law.).
whose -benefit work is performedunder 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• s: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 Quints, 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 Isnot 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 l have read this application and,state that•the above information is correct. I agree to comply with all
city and county.ordinences and state laws relating to buildi nstruction, and hereby autho '7represeives
of this co to enter upon the above-mentioned' props orcti purposes.
Da Signature l 4pplicent or Agerttl:�—
Application Number . . . 05-00001976
Permit
. . . BLDG POOL PERMIT
Additional
desc . .
Permit. Fee
207.00 Plan Check Fee
134.55'
Issue Date
. . . Valuation . . .
. 20000
Expiration.Date
. . 11/19/05
Qty Unit Charge Per
Extension
BASE FEE
45.00
18.00
9.0000 THOU BLDG 2,001-25,000
162.00
Permit
. . . MECH POOL
Additional
desc .
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date
. . . . Valuation . . .
. 0
Expiration,
Date . . 11/19/05
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
desc . .
Permit Fee
. . . . 45.00 Plan Check Fee
11.25
Issue Date
. . . . Valuation . .
0
Expiration
Date 11/19/05
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
. . . . 3.3.00 PlanCheck Fee
8.25
Issue Date
. . . . Valuation . . .
. 0
Expiration
Date 11/19/05
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
ONLY. ALARMS/BARRIERS SHALL
LQrERUr
Application Number . . . . . 05-00001976
------------------
Special Notes and Comments r
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid Credited Due
Permit Fee Total 311.00 .00 .00 311.00
Plan Check Total 160.55 .60 .00 16.0..55
Grand. Total 471.55 .00 :00 471.55
LIQPEReflx
I�
Bin #
'
Clly-Of, , a. Qulnb : .
Building 8t Safety Dilnsion .
P.O. Box, 1504, 78-495 G((e Tampico .
La Quinta, G4 92253 - (760) 777701,2
Building Permit Application and Tracking Sheet.
Pefmit,
Project Address: � - �
Owner's Name:
A., P. Number.
'Address. '.
Legal Description:
City,; ST, Zip:
Contractor.
Telephone:
`
Address: �-
Project Description:
City, ST; Zip: a
Telephone:
A.f�•.':`C`."+:'?:..'�J:iV
:� " �3f'w� t' y
h'?.` -iii::: -r- i.:i::;f:,`. .•{'}..'w°'.�.'i-'X'/.-v:'
State Lic. # :
City Lica#: l r
Arch., Eno Designer
Address:
City, ST, -Zip:
"
.. ,..• �.. _� '- -h4` - -ro' yr � : ::d:
Telephone: _.:.,;; .r< ,: ..
State Lic. #:Project
. '7r.H,•;`r.'•::riY.^�:: `r+hY.-+r'4•,:.}i'2•T±Sx
_•
Construction Type; Occupancy:
rcle one '
type Add'n Alter Repair-, Demo'
Name of Contact Person:
Sq. Ft:
# Stories:
# Units:.
Telephone # of Contact Pers
Estimated Value of Project 4 -
APPLICANT: DO. NOT WRITE BELOW THIS LINE
!1
Submittal
Req'd
Recd
TRACRING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check• Deposii
TiumCales.
:Called Contact Person
Plaa Check Balance
Title 24, Calca.
Plans picked lup
Construction
Flood plaiit•plan -
Plans°resubmitted
Mechanical
Gmding plan
2'' Review, ready for correetionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans. resubmitted
Grading
IN 11 OUSE:-
'''Review. i eady 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 Fres
8
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IV
I a
i
RANCHO SANTANA
LOT 54
► MODEL PLAN 3
I-ACCA
STELAE
TILE,
BOULDERS,
DECK COLOR
CENTRELLER
PEBBLE
PLASTER
DAM WALL
EQ WALL
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