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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