05-1772 (RPL).o
CO
P.O. BOX 1504 . f j o
78-495 CAI:LE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4t(t 4 e(P Q"
Application Number: C 05-00001772
Property Address: 46370 CAMEO PALMS DR
APN: 643-182-026-3 -2043 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 18000
Applicant: Architect or Engineer:
-
FMAY i aDS
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CHESTER JIM
46-370 CAMEO PALMS DRIVE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:
FAMILY POOL CONSTRUCTION
WCC: STATE FUND
WC: 1344032-2005 03/01/06
CSLB: 658996 11/30/06
Date: 5/10/05
-
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'.vranl.t ICENSED CQNTRACTOR'S DECLARATION
I hereby affirm under pen �! of penury d under provisions of Chapter 9 (commencing with
coon 7000) of Difiiq;3�the Businessland Professionals Code, and rrwTcense is in full force and effect.
Licenses: Lj ! ! License No.91
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that Ilam exempt from the Contractor's State License Law for the
following reason ISec. 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 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.).
(_) 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
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
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 issued32006r
My workers' compensation
insurance carrier and policy number are: /2i % q0 3 Z .G7 6
Carrier C53-HIC Policy Number ! C/r
J
_ 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 t come sub'ect to the workers' compensation laws of California,
and agree that, if I should bec ect to the workers' compensation provisions of Section
3700 of the Labor Code, - f rthwith comply with those provisions.
Xe. Applicant:
WARNING: FAILURE TO SECURE WORKERS'OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENAL IES 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 thea ' v ormation is correct. I agree to comply with all
city and county ordinances and state laws relating to bui construction, and hereby authorize representatives
of this u ty t en r upon the above-mentioned pro rty 'n ection purposes.
0 1 Signature (Applicant or Age
Application Number . . . . . 05-00001772
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
189.00 Plan Check Fee
122.85
Issue Date . . . .
Valuation . . .
. 18000
Expiration Date . .
11/06/05
Qty Unit Charge
Per
Extension
BASE FEE
45.00
16.00 9.0000
- ----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
144.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
11/06/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
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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
11/06/05
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
33.00 Plan Check Fee
7.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
11/06/05
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
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Special Notes and Comments
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
BE IN PLACE PRIOR TO
PRE -PLASTER
INSPECTION. EQUIPMENT
ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged
---------------------------
Paid Credited
------------------------------
Due
Permit Fee Total
293.00 .00 .00
293.00
Plan Check Total
148.10 .00 .00
148.10
LQPERMIT
Application Number . . . . . 05-00001772
----------------------
Special Notes and
----------=---
Comments
-----------
-----------------------------
INCLUDED IN PERMIT'.
Fee summary
-----------------
Charged
----------
Paid
----------
Credited Due
----------
Permit Fee Total
293.00
293.00
----------
.00 .00
Plan Check Total
148.10
148.10
.00 .00
Grand Total
441.10
441.10
.00 .00
LQPERMIT
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A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
NO EXCEPTIONS!
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCT
f1N