05-2868 (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:
OSS_ 0028M68�
57550 SANTA ROSA TR
762-240-013-19 -34087
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
17000
Architect or
BUILDING & SAFETY' DEPARTMENT
BUILDING PERMIT
LICENS D TRACTOR'S DECLARATION.,
I hereby affirm under penalty of perjury that I am I e -ed -oder provisions of Chapter,8,(commencing with
Section 7000) of sign theBusine s No and P fes ' Is Code; and m Lic +s-in'f I f�r� and effect.
License Class: } ^ -License ri p ' +
` � �/
aiDate ntract
- 0WNN R -BUIL ER DECLARATION
hereby affirm under penalty of perjury that,l am ezel f fro .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 struciure,. prior.fo its issuance also requires the applicant for the
.permit to file a signed§taternent that he or; she is licensed pursuant to the provisions sof 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 exeinption. -Any•violation of Section 7031.5 by
any applicant fora:permit subjects the applicant to_a civil penalty of not more:than`five hundred. dollars ($500).:
( 1 as'owner'of.the property,�er.my employees with wages as their sole compensation, will _dothe work, and .
.-the structure isnot intended.or.offered for.sale (Sec. 7044, Business and Professions Coder The
Contractors'astate+License Law does not apply to an owner of property who,buijds or improves thereon,
and ,who -does the work himself or herself'through his or lierown-ernpI'y -s 0ovided thati'the: '
improvements are not intended or offered forsale. If; however, iiie building'or improvement is'sold within
one year of completion; the owner-builder'will have the bu?den of,proving that he or she -did not build or
improve for thepurpose of sale.). -
(_ 1 I, as ownerof the property,: am exclusively contracting with licensedicontractors to construct the project (Sec.
7044; Business'and p ofessions Code: The -Contractors' State License Law does not apply-to•an owner of
property who builds or improves thereon, and who contracts for thio projects with a contractor(s)•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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/11/05
Owner:
SANTA.ROSA DEV
40847 SANDPIPER CT.
PALM DESERT, CA 92260
Contractor:
CALIFORNIA POOLS.& SPAS
WCC: SEABRIGHT INS
WC: BB1050510 01/01/06
CSLB: 656,128 10/31/06
------------------
WORKER's COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain acertificate of consent toself,insure for workers' compensation, as provided
for by Section 3760'of:the Labor Code, for. "the performance of�tlie work for which this permit is
issued.' \ .
I have and will maintain workers' compensation insurance, as required by Section 3700'of tlieLabor
- Code, for.the performance. of tkforwhich thispermrt is issued. -My workers',compe anon
insurance carrier and policynuCarrier, C8 C27'.C29;C53 bar Q:0 (�I certifythat, in the performance or.which this permit isissued, I shall not employ any
.person in any manner. so as toctto the workers' compensation laws of California,
and agree that, if�fshobeco the workers' compensation -provisions of•Section
37 of the Labor e 6shaomply with those provisions.
D e pIican:".
r
WARNING: FAILURE TO SECURE RKERS' COM ENSAT N COVERAGEIS.UNLAWFUL, AND SHALL.
' SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A ,CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS J$100;00M. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706OFTHE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
APPLICANT ACKNOWLEDGEMENT
IMPORTANT' Application Js 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; itsofficers,.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 if work is not commenced
- within 180 days from date of issuance of such permit, or ce - ation o work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above informa Xict. I agree to comply with all
city and county ordinances and state laws relating to buil ' nstructio y authorize representatives
of this c �y o en r upon the above-mentioned prop y r nspe on -
Da�; i ature (Applicant or Agent).
LQPERMIT
Application Number . . . . . 05-00002868
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
----------------------------------------------------------------------------
135.00
Permit• . . . . MECH POOL .
Additional.desc .
*Permit Fee 26.00 Plan Check Fee
6.50
Issue Date ... Valuation . . . .
0
Expiration.. Date 1/07/06
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
Expi;ratiori Date 1/07/06
Qty Unit. Charge Per
Extension'
BASE- FEE .
'l5'.,00'-
`1:00
1; 0:030..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 q
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/BARRIER SHALL
LQPERMIT
Application Number . . . . . 05-00002868
----------------------------------------------------------------------------
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
LQPERMIT
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
UPApplication Number:
05-00002868
ropertyAddress:
5.7'55-0—SANTA ROSA TR
AM:
762 -460 -019 -
62-460-019-Application,description:
Application description:
.POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
17000
Applicant:
s a
"
-------------------
I hereby affirm under. penalty of perjuryt I art
Section 7000) of; Division 3 of the Busi ess'and-
i�an�a cu�tJ CA r_27'.,C!29
T419 4 4:Q��
Architect or Engineer: -
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SANTA ROSA DEV
40847 SANDPIPER CT
PALM DESERT, CA 92260
Contractor:
TESERRA
P;:"O:''Box 1280
COACHELLA, CA 92236
(760.)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/15/07
------ ---- --- --
�. •O . — ----
NTRACTOR'S DECLARATION C= -' — COMPENSATION ?DECLARATION
enshereby
-=-.-
under provisions ofCha ter 9 (commencirig with I h reby affirm n er pen Ity of per' ry one o�f the f 11 wing,decIo
rations.
�feasi rials Code; and my License is in full force and effect. _ .I have andtwill maintain a certificate of consent to'self-insure for,workers"compensation; as provided
UcenseNo :'-656128 . �.-.for by SecnonB700'of the ;Labor Code,.for the performance of the work for which this permit is
�� s ^ ' issued. _ .-r
A-
7ate: ` Contractor: .-- _ I have and will maintain workers compensation insurance, as required by Section 3700 of the Labor
I *.. s _ Code, for theDerformance of thew k for which this.,_permrt is issued. My workers' compensation.
O NER-BUILDER DECLARATION , insurance'carrier'and policy number a
hereby affirm under: penalty of perjury :am empt from.the Contractor's State License Law for.the Carrier SEAB&IGHT - '-� .o cv.. ber. BB10,70516
following reason.(Sec;-7031 .5, Business and Profeions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, dor repair any str cture; prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is lic seo,pursuant to the provisions of the Contractor's State
License Law (Chapter.9-(commencing with.Section 70001 of Division 3 of the Business and Professions Code) or
that .heor.she is exempt therefrom'and-the basis for the'alleged exemption. Any violation of Section 7031.5 by
any a_pplicant:for aipermit subjects the applicant to.a civil penalty of. not. more than five hundred dollars ($500).:
1 ).'I, as, owner,of the property, or my employees with -wages as then sole compensation,,will'do the work, and
the structure isnot intended or'offered for sale+(Sec. 7044, Business and,Professions Code The_
-Contractors' State License Lawdoesriot apply to'an,ownerr.of property who builds or, improves thereon,.
and who does,the work,himself or herself through his or her own employees, provided that the T x
improvements are not intended`or offered'for-sale. If, however, the building or improvement Is:sold within
one yearof, completion, the owner -_builder will have.the burden of proving that he or she did not'build or
improve for the purpose of sale.).
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project'(Sec.
7044Ausiness and. Professions Coder The Contractors' State License Law does not apply to an owner of
property who builds.or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
.LQPERMIT
_ I certify that, in the performanc of th `��ht
($( for hich this permit is issued,.] shall not employ any
person.in any manner so as o beosLbject t the workers', compensation laws of,California,
and agree that, if I should come. lt to the orkers' compensation provisions of Section'
`3700 of theLabor.Code, I sh comply ith those provisions..'
13 te: Llr J l Applicant: A
W NING t FAILURE TO SECURE WORKERS':. PENSATION COVERAGE IS. UNLAWFUL, AND SHALL
SUBJECT AN'EMPLOYER TO:CRIMINAL PENALTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,000). IN ADDITION TO THE COS OF COMPENSATION, DAMAGES,AS PROVIDED FOR IN
SECTION 3706 -OF THE LABOR CODE, INTEREST, ND ATTORNEY'S FEES.
APPLIC NT ACKNOWLEDGEMENT
IMPORTANT Application'ishereby made to the Director of'Building and.Safety fora.permit subject to the
conditions and restrictions set forth on this application.
1. . Each person upon whose:behalf this application'is mad each person at whose request and for
whose benefit work is performed under or pursuant to ny permit issued,asa result of this application,
the owner, and the applicant, each agrees to, and shall efend; indemnify and hold harmless the City
of La Ouinta, its officers, agents and employees for an act or`oiiiission related to the work being
performed under,or following issuance of this permit. i
2. Any permit issued as a result of this applicatio(ovjei
II and void if work is not commenced
within 180 days from date of issuance of sucor essation of work for 180 days will subject
permit to cancellation.
I certify that I have r d this application and state that the orma 'on is correct. I agreeto comply with all
city and c my or ances nd state laws relating to buildiuctio ,.and hereby authorize representatives
of this co�ty to po t�3hove-mentioned propertyctio purposes.
(Applicant or Agent):
Application Number . . . . . 05-00002868
Permit
. . . BLDG POOL PERMIT
Additional
desc . .
Permit Fee
. . . . 180.00
Plan Check Fee
117.00
Issue Date
. . . . 7/21/05
Valuation . . . .
17000
Expiration
Date 1/17/06
Qty- Unit Charge Per
Extension
BASE
FEE.
45.00
15.00
----------------------------------------------------------------------------
9.0000 THOU BLDG
2,001-25,000
135.00
Permit
MECH POOL
Additional
desc .
Permit Fee
. . . . 26.00
Plan Check Fee ..
6.50
Issue Date
. . . . 7/21/05
Valuation . . . .
0
Expiration
Date . . 1/17/06
Qty Unit Charge 'Per
Extension
BASE
FEE
15.00
1.00
-------------------------7--------------------------------------------------
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
. . . . 7/21/05
Valuation
0
Expiration
Date 1/17/06
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
7/21/05
Valuation . . .
0
Expiration
Date 1/17/06
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/BARRIER
SHALL
LQPERMIT
Application Number . . . . . 05-00002868
----------------------------------------------------------------------------
Special Notes and Comments
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
----------------------------------------------------------------------------
Other Fees . . . . . . . CHANGE OF CONTRACTOR 4.50
REPLACEMENT INSP CARD 15.00
Fee summary Charged Paid. Credited Due
Permit'Fee Total 284.00 284.00 .00 .00
Plan Check Total 143.00 143.00 .00 .00
Other Fee Total 19.50 .00 .00 19.50
Grand Total 446.50 427.00 .00 19.50
LQPERMIT
Bin, #
Submittal
C1t e '.
' Rec?d `
TRACKING: i}' , a'
;Of Who
Plan Sets
Building 8t Safety;Division
P O. -Box 1504, 7&495 Calle.Tampico
Permit #
Plan.Check submitted
7.Item:
La Q;inta, CA -92253 - (760) 777-7012
Structural Cales.
Building Perritt Application -and. Tracking Sheet
Project Address:j • j 50s
Reviewed, ready for corrections r
"Owner's Name: s i
A -P. Number:
Address:
Legal Description:
p'`
Sity;.ST,-Zip:
Contractor:Tele
L' Fo vvGs
P hone: .
S
......
Address:®x �(
Plansicked u `
P� - P
Project Description:
City, ST, Zip;.Can tA e 1 (4
0 .
r : .
BOOL: 6.5 PA.
Telephone: s9Z
{
Mechanical
Grading plan
f
StateLic. # : ��
2"d Review,'ready for corrections/issue
City Lic. #c 'x
,
Arch.; Engr., Designer.
'
3
�
.Address:
Grant Deed
•Plans picked up -
City, ST, Zip:
S.M.I. i
H.O.A. Approval
> Tele hone:
P
s .::,::•} K� , r O r t
?a•' w�
Construction Type. Occupancy:
• ,, /F :: .: kvv}}^.r.Jn,tl::n {Si'y/
" ':?>
_
State Lic. #:
_
'^'" `'
tf ::':'' F
Pro ect a circle one Ne Add n'.
�_. .J tYP f ) Alter Repair Demo
•
Name -of Contact Person-', A F
t
�� ,i; ' '' <
�Sq:'Ft : ;
# Stories:
# Units:.
Called Contact Person' }
Telephone # of Contact Person: Z �•-% 4. � $`=�i Ar
"Estimate`d Value of Project:
Pub. Wks. Appr
APPLICANT: DO'NOTWRITE BEL01N`THI§ LINE,
#
Submittal
Req'd
' Rec?d `
TRACKING: i}' , a'
, PERMIT FEES
Plan Sets
Plan.Check submitted
7.Item:
Amount
Structural Cales.
Reviewed, ready for corrections r
j
Plan:Check Deposit
Truss Calcs.
Called Contact Person
•
.
i• i
Plan `Check Balance
Title 24 Calcs.
Plansicked u `
P� - P
'Constructio,n"
Flood plain plan
Plani"r, ubmitt d .
Mechanical
Grading plan
2"d Review,'ready for corrections/issue
Electrical ,
Subcontactor List
Called Contact Person •
' Plumbing
Grant Deed
•Plans picked up -
S.M.I. i
H.O.A. Approval
'Plans resubmitted �: ,�
.Grading
IN HOUSE:-
'"' Review, ready or correcGonsrksue
Developer Impact Fee
Planning Approval
Called Contact Person' }
A.LP:P. ,
Pub. Wks. Appr
Date of permit issue
School Fees
}
__
Total Permit Fees
I