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05-2869 (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 0000=286- 9� 57524 SANTA ROSA TR' 762-240-013-18 -34087 POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 1.7000 watt 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: Owner: SANTA ROSA DEV 40847 SANDPIPER CT PALM DESERT, CA 92260 q o a ra ��+/; O 3 CALIr IA POOLS & SPAS 200jCC i SEABRIGHT INS VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/11/05 o,p WC: BB1OS0510 01/01/06 " Cil O B 656128 10/31/06 l:0 A / --_•---------------------------------------------------------------------------------------------- ._�,_ LICENSED CONTRACTOR'S DECLARATION.' - . WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury that I am licensed 'under provisions of Chapter 9 (commencing with .1 hereby affirm under penaltyofperjury one of the following 'declarations: Section 7000) of Division 3 of the Business and Professionals Code, ahb my License is in full -force and effect. I have and. will maintain a certificate of consent to self -insure for workers' compensation, as, provided License Class: - `License No.: (o g'.fo / 2. - foctiy�section.3760 of the Labor Code, for the performance of the work for which this permit is- . - .. .. D�att; Contractor -. - issued. - h I have and will maintain, workers' compensation insurance, as required by Section 3700 of the Labor Code, for.the,perform_ ance:of the work for which this permit is issued. My workers' compensation =:� .... OWNER -BUILDER. DECLARATION. I hereby affirm under penalty of perjury that I am exdimpffrom the Contractor's State.License Law for the insurance carrieFand policy number are: // Carrier C8 C21 C29 '1253 ' -' Policy Number Q.��Ef` following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to I certify that,. in the performance of the work for which this permit is issued, I shall not employ any construct; alter, improve, demolish, or`repair;any structure, prior to its issuance; also requires the applicant for the person in any manner sous to become subject to the'workers' compensation laws of. California, permirto file a signed statement tharhe or she is licensed pyrsuant to the provisions. of, tlie�Contractor's State and agree that, if 1 should become subject to the workers' compensation provisions of Section .License Law (Chapter9 (commenting withSection 7000) of Division.3 of the Business and-ProfessionsCode) or 3700.of the Labor de, I sh comply with those provisions. - that lie or she is exempt therefrom andrthe basis for the. alleged exemption. Any violation of Section -7031.5 by any applicant for a permit subjects the applicanvto a civil penalty of not more than five hundred dollars 155001.: �� DW,t57 .3wy Applica 1 _ 1 'I, as owner of the property; or -my employees with wages as their sole compensation, will do the work, and •the structure isnot intended or offered for sale'fSec: 7044Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS°COMPENSATION COVERAGE•_IS UNLAWFUL, AND SHALL Contractors ;State License Law does not apply to an ownei of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and whodoes the work himself,orherself through his`br herown'employees;provided that the DOLLARS ($100,000): -IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN improvementsare:not intended.or offered for sale.' If, however,'the.building or improvemenlis sold within SECTION 3706 OF THE LABOR CODE; INTEREST, AND, ATTORNEY'S FEES. oneyear 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" APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the 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 Law does not apply to an owner of conditions and restrictions set forth on this application. .property who builds orimproves thereon, and who contracts for the projects with a contractorls) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under 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 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 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 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 roperty for ins ction purposes. Datef -?—S Signature (Applicant or Me Application Number . . . . . 05-00002869 Permit . . . BLDG POOL PERMIT Additional desc . Permit.Fee 180.00. Plan Check Fee 117.00 Issue Date . . . . Valuation 17000 - Expiration Date 1/07/06 Qty Unit Charge Per Extension BASE FEE 45:.00 . 15.00 9.0000 THOU BLDG,.2,001-25,000 135.0,0 Permit MECH POOL Additional desc - Permit Fee . . 26.00',:: Plan Check Fee 6.50 ,. Lssue Date Valuation 0` Expiration Date 1/07/0.6 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 - ValuaOi n. 0 Expiration Date 1/07/0;6; - 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 1/•07/,06 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 LQPERMIT Application Number . . 05-00002869 ---------------------------------------------------------------------------- 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 284.00 .00 .00 284.00 Plan Check Total 143.00 .00 .00 143.00 Grand Total 427.00 .00 .00 427..00 LQYERMIT # Submittal Req'd Rec>d Bin # PERMIT FEES City o1 La Quin Building 8r SafetyDivision P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking. Sheet Permit # 05-2 8 4 Project Address: -5-7-5-2y Owner's Name: 07 1+T A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: Telephone:`»3<'`>'?`:^ '':{:<::>'>•'':: Cc�� i ®oL,s its Address: C) i3®x I Z%O Project Description: City, ST, Zip;. C tXA CA e I L4 1A 3 (0 DooL Telephone: ;:;'...::. i::.}i�.::: v.t.i.. xis:!:::•$�:?�f State Lie. # Arch., Engr., Designer: S City Lic. #: Address: -K J City, ST, Zip: Plan Check Balance Telephone: State Lie. #:} Construction Type: Occupancy: :`•'>•;4#;> v; « '>' F# r Project type (circle one): Ne Add'n Alter Repair Demo Name of Contact Person: DAN �'��' Sq. Ft.: ' # Stories: # Units:. Telephone # of Contact Person: �'�%��f "p�i� Estimated Value of Project:. APPLICANT: DO NOT WRITF RFI OW TI -11-4Z 1 INR' # Submittal Req'd Rec>d TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan. Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs.. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading .IN HOUSE:- Review, ready for correctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees