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05-3958 (RPL)P.O. BOX 1504 . 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:0 05 00.03.958 Property Address: 78710 ROCKBERRY CT APN: 604-431'-Q19-27 -23995 - Application description: POOL - RESIDENTIAL . Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 40000 T4&t 4. 4 Q". .BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: BOYDSTUN GARY 78-710 BOCKBERRY COURT LA QUINTA, CA 92253 VOICE (760) 777-7012 . FAX (760) 777-7011 INSPECTIONS (760) 777-7153 n Contractor: Applicant: Architect or Enginee D Lr� a AINSWORTH POOL CONSTR, ROBERT WCC: VIRGINIA SURETY WC: 005-0024833 01/01/06 SEP 14 200CSLB: 598681 07/31/06 CITY OF L.A QUINTA). -------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am ' sed under provisions of Chapter 9 (commencing with Section 7000) of Division _ 3 of the Business an Profe sionats Code, and my License is in full force and effect. License Class: Lice No.: /te:�,��1n5 Contractor 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 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 contractors) licensed pursuant to the Contractors' State License Law.). 1 _ 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 Date: 9/12/05 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 Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier 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 beco subject to the rkers'- compensation laws of California, and agree that, if I should becq s je to the 'compensation provisions of Section 3700 of the Labor all fort with amply iose provisions. atD e: r 6I�S Appli nc t: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 15100,0001. 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. i . 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 infor is correct. I a9ree to comply with all city and county ordinances and state laws relating to.buiWconstruiota hereby nze representatives.of this c unt t er upon the above-mentioned gropenrp ses. �� Signature (Applicant or Agent). .. Application -Number . . 05-00003958 Permit . . . BLDG POOL PERMIT Additional desc . Permit Fee . . . . 349.50 Plan Check Fee 227.18 Issue Date Valuation 40000 Expiration Date 3/11/06 Qty Unit Charge Per Extension BASE FEE 252.00. ' 15.00 6.5000'THOU BLDG 25,001-50,000. ----------------------------------------------------------------------------- 97.50 Permit MECH POOL Additional desc . Permit'Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . Valuation 0 Expiration Date 3/11/06 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 3/11/06 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 33.00 Plan Check Fee 8.25 Issue Date . . Valuation_ 0 Expiration Date 3/11/06 Qty Unit Charge. Per Extension BASE FEE 15.00 2.00 6.0000 EA PLB FIXTLF?,8 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 LQPERMIT Application'Number ... . . 05-00003958 ------------------------------------------------------------------- ----------- ------------------------------------------------------------------- Special Special'Notes and Comments BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary. Charged Paid Credited Due Permit Fee Total 453.50 00. -253..18 .00 453.50 Plan Check Total .00 .00 253.18 C Grand Total 706.68 .00 00 706.68 Sent By; AINSWORTH POOLS; 7602000040; Sep -12-05 4:25PM; Page 1/2, 7607777011 LA OUINTA r..� uA.vi 01/z6/288a 16:10 • A IL x X A A x w o City of U QUinta 9uiWkq a Ssfeq NvUloo P.4. &= 1 SO4, 79-495 Cak Tse lentth 1 La Quittu, U 92253 - (7,60) 777-7012 05,395S Building Perntit Application and Tricking Sheet tropceA�atrsi :.'.{x"'1.•(:0 ..__ U�U�Y... C Q N EAdWdlls iV.S ' 1� 1; on jf 2 JJta: LkL.- 4oo , L1- �,pR (� . . o L r SEA Car. ST. Zip: CA L J- ti n i Tviq* + - )j00 Stoic Lac. r rj lt(� Ictlytc. e: AtWets: City, ST. Zip Taleyltotae: �y `� A Contwcuvw Tree Qccewawcr Sim Lte, 0: 1 : •. ftk*1-VP- Itrstf wwe): W-- A4d-n AIM Itglir Orme, taw ofCOWAP Pers": Tui s�. it.. ttitWWd V kl of tet. 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