05-4267 (RPL)P.O. BOX 1504 -4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS '(760) 777-7153
Application Number: <0.5-0000426 v Owner: '
Property Address: 54140 WEST RESIDENCE CLUB. DR NADADOR; LLC
APN: 775-380-999-6 -31627 - 4 78120 CALLE ESTADO, SUITE.'203
Application description: POOL - RESIDENTIAL U� LA QUINTA, CA 92253
Property Zoning: MEDIUM DENSITY RES /0 7
Application valuation: 10000
c� Contractor:
Applicant: Architect or Engineer: tcD CALIFORNIA POOLS' & SPAS
WCC- SEABRIGHT INS
WC: BB195'0510 01/01/06
CSLB: 656'128 10/31/06
1;
-------------7-----------7------------------------
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.
License Class: C 5-3� _ . License No.: TL t .t :'
ate: �f�2't�eS— Contracfo
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 ($500).:
(_ 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. , B.&P.C. for this reason
t
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
Date: 9/21/05
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
r Code, for the performance of the work for which this permit is issued. My worker' compensation
insurance carrier and policy number are:
Carrier C8 C2,7 C29 C53 Policy Number - - - - - - - - - - - - - - -
I certify that, in the performance of the work for which this permit is issued, I shall no :employ any
person in any manner so as to become subject to the workers' compensation laws pf California,
and agree that, if I should become subject to the workers' compensation provisions pf Section
t/T� 3700 of the Labor Code, I shall forthwith comply with those provisions.
Da/te: ^C �-"��Applicant: `
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND $HALL
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 PROVIDQD 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 wi�l 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 this county to enter upon the above-mentioned prope .1for inspection purposes.
D ta.. 1 Signature (Applicant or Agent). _ ^�
Application Number
05-00004267
Permit
BLDG POOL PERMIT
BASE
Additional desc .
15.00
1.00
6.0000 EA
PLB
Permit Fee . . . .
117.00
Plan Check
Fee
76.05
Issue Date . . . .
3.00
Valuation
. . .
. 10000
Expiration'Date
3/20/06
-3_0000-EA-_--PLB
Special Notes and Comments
Qty Unit Charge
Per
ALARMS/BARRIERS
SHALL
Extension
BASE
FEE
45.00
8.00 9.0000
------------ w
THOU BLDG
2,001-25,000
72.00
MECH POOL
Additional desc .
Permit Fee . . .
24.00
Plan Check
Fee
6.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
3/20/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9.0000
--------------------------
EA MECH
-----------
FURNACE <=100K
-------------------
-------
9.00
-------------
Permit
ELEC POOL PERMIT -RES
..Additional desc .
Permit Fee . . . .
45.00
Plan Check
Fee
11.25
Issue Date . . . .
Valuation
. . .
0
Expiration Date
3/20/06
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 . . . .
27.00
Plan Check
Fee
6.00
Issue Date
Valuation
. . . .
0
Expiration,.Date . . 3%20/06
Qty
Unit Charge Per
Extension
BASE
FEE
15.00
1.00
6.0000 EA
PLB
FIXTURE
6.00-
1.00
3.0000 EA'
PLB
WATER INST/ALT/REP
3.00
1.00
GAS PIPE 1-4 OUTLETS
3.00
-3_0000-EA-_--PLB
Special Notes and Comments
SPA ONLY.
ALARMS/BARRIERS
SHALL
BE IN
LQPERMTT
Application Number . .. . . . 05-00004267
Special Notes and Comments
PLACE PRIOR TO PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED IN
PERMIT.
Fee summary Charged Paid Credited Due
Permit Fee Total 213.0'0 .00 .00. 213..00
.Plan Check Total 99.30 .00 ..00 99.30
Grand Total— 312.30 .00 .00.. 312.30
LQPERMff _ _
Bin. # City of La q uin to
Building8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
Pennit # La Quinta, CA 92253 - (760) 777-7012
Of �' �(14.. Building Permit Application and Tracking. Sheet
ProjectAddress: 5C� 80 Owner'sName:—PW�
A. P. Number: Address:
T -I Tlacrtrintinn' City, ST, Zip:
Contractor: Cai:
Address: 0 0 S19x i-�4�
City, ST, Zip: 6x cli C
Telephone:��- �� 2
State Lic. #
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Naine of Contact Person: )
Telenhone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
M
Lic. #:
• •1 Project Description: -
nimg"g' �"' ` Construction Type: Occupancy:
cY:
A
Project type (circle one): Ne Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:•
Estimated Value of Project:.
16"0>0 a
APPLICANT: DO NOT WRITE BELOW THIS LINE
Grading
Recd TRACKING
Plan Check submitted /
PERMIT FEES
Item Amount
Reviewed, ready for corrections
Plan. Check Deposit
Called Contact Person
Plan Check Balance -
Plans picked up
Construction
Plans resubmitted
Mechanic al
2r'Review, ready for correctionsrssue
Electrical '
(`ollnd CnntartPerenn
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
.IN HOUSE:- .
Review, ready for corrections/issue
Developer Impact Fee.: s
Planning Approval
Called Contact Person
A.I.P.P.
Pub. �Vks. Appr
Date of peymit issue
School Fees
Total Fermat Fees