06-3828 (SOTB)P.O. BOX 1504
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T -,&t 4 4 Q"
Application Number:
06-00003828
Property Address:
81858 COUPLES CT
APN:
764-060-051- - -
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1000
Applicant: Architect or Engineer:
1"' l
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 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
U nseCla 27 V� 823017
�� ontractor: AG
OWNER -BUILDER CLARATION ✓✓✓
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 anystructure, prior to its issuance, also requires the applicantforthe
permit to file a signed statement: that he'or she is licensed pursuant to the provisions of the Contractor's State
Ucense,Law.(Chapter 9 (commencing with,Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exemphtherefrom and the basis for the alleged exemption. Anyvtolation of"Section 7031.5 by
any applicant for a permit subjects the applicant to -a civil penalty of notmore than five hundred dollars ($500).:
(_ 1
1, as owner of the property, or my employees with wages as their sole compensation, will do -the work, and .00
the structure isnot intended or offered for sale (Sec. 7044, Business:and Professions Code: The
Contractors' State License Law does,not apply io 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 1, as;dwner 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 hot apply to an owner of
property who builds or improves thereon, and who; contracts for the projects with a contractor(s).licensed
pursuam.to the Contractors' State License Lew.).
(_) 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 constructionJending•agency forthe performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: 0114
LQPERMIT
Owner:.
TOM LOSS
81858 COUPLES COURT [k),
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/25/06
Contractor: f®®t
MCRAE POOL & SPAS 6
79105 DESERT STREAM .DR R/y
LA QUINTA, CA 9:2253
(760)772-2440
Lic. No.: 823017
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 io 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 EXMP.T Policy Number EXEMPT
I certifythat. inthe performance ofthe 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- .Labor
ate: / Applicant:.
WARNING: FAILURE TO SECUR ORKERS' COMAE COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES.AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 19100,000). 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:benefk work is performed under or pursuantto 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'Ouinta, its officers, agents and employees for any act or omission related to the work being
performed underor 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 thWapplication and state that the above jnformatlon incorrect. I agree to comply with all
city and county ordinances rand state)aws relating to building construction, and hereby authorizerepresentatives
Of this c to enter upon thea e-mentioned.propertyy pect'on purposes.
Sig re (Applicant or Agent):
Application Number . . . . . 06-00003828
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 25.00 Plan Check Fee .
Issue Date . . . . Valuation . . . .
Expiration Date . . 4/23/07
16.25
1000
Qty
Unit Charge Per
Extension
BASE FEE
15.00
5.00
2.0000 HIND
BLDG 50.1-2,000
10.00
--------------------------
Special
Notes and Comments
FIREPIT
PER APPROVED .PLAN
------------------------------ ----------
----------- ---
Other Fees . . . . . . . .
Other
I -----------------------------------------
. ENERGY REVIEW FEE
1.63
STRONG MOTION (SMI) - RES
.50
Fee .summary Charged
Permit Fee Total 25.00
Plan Check Total 16.25
Other Fee Total 2.13
Grand'Total 43.38
LQPERMIT
Paid Credited Due
.00 .00 25.00
.00 .00. 16.25
.00 .00 2.13
.00 .0.0 43.38
PA
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