05-2928 (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=00002928`
57591 SANTA ROSA TR
762-240-013-14 -30487
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000
COWRA`( T -ole{
Architect or
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012'
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/14/05
Owner:
SANTA ROSA DEV
40847 SANDPIPER CT
PALM DESERT, CA 92260
Contractor:
JUL 2 O CASA VERDE LANDSCAPE
2005 WCC: GRANITE
WC: 9549987
CITY OF LA QUINTA CSLB: 624647
LICENSED -CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that Iam licensed under.provisions of Chapter'9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full forceand effect.
License_ Class /may, - License No.: _
D e: �� .Contractor:,X/dT
.�, OWNER -BUILDER DECLARATIONI
I hereby affirm under, penalty of perjury that I am exempt from_the Contractor's.State'License Law for the _
following reason (Sec. 9031.5, 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 sheis licensed pursuant to the provisions of the Contractor's State
License'Law-(Chapter.9;(commencing with Section 7000);of-;Division 3 of the'Susiness and Professions -Code) or
that he or she is exempt therefrom and the basis for the alleged exemption:-. Any yiolation'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).:
(_) 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 -
. sConfractors'.State License Law does not'apply to ar 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.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—) 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 thispermit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
MAINT COR
09/05/05
08/31/06
------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the followingdeclarations:
have and will maintain a certificate of consent to self -insure 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 requiredby Section 3700 of the Labor
,Code, for.the performance of.therwork for which this permit is issued: M workers' compensation
insurance carrier and policy number are:
Carrier C-27, _ Y 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 become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shallforthwith comply with those provisions.
Date? W a Appl[can
WARNING FAILURE TO SECURE WORKERS'COMPENS,ATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). IN ADDITION TO THE COST 0,F COMPENSATION; DAMAGES ASPROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
- - APPLICANTACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Directorof Building and Safety for a permitsubject 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 aresult 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 tieing
performed under or following issuance of this permit. '
2. Any permit issued as a result of�this application becomes null and void if work isnot 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 I agree to comply with all
'city and county ordinances and state laws relating to building construction, d hereby authorize representatives
of this cou ty to enter upon the above-mentioned prope sp o urposes.
Date' Signature (Applicant or Agent):
r
LQPERMiT
Application Number .
. . . . 05-00002928
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
207.00 Plan Check
Fee
134.55
Issue Date . . . .
Valuation
. . .
. 19824
Expiration Date
1/10/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
162.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check
Fee
6.50
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
1/10/06
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
1/10/06
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
1/10/06
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
Permit . . . . . . WALL/FENCE PERMIT
r
LQPERAIIT
IR
Application Number
Permit . . .
Additional.desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date .
. . . . 05-00002928
WALL/FENCE PERMIT
15.00 Plan Check Fee
Valuation
1/10/06
.00
176
Qty Unit Charge Per Extension
BASE FEE 15.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL & SPA ONLY. 11 L.F. 4- EQUIPMENT
BLOCK WALL, CITY STANDARD.
ALARMS/BARRIERS SHALL BE IN PLACE PRIOR
TO PRE -PLASTER INSPECTION.
Fee summary Charged Paid Credited Due
----------------------•-----------------------------------
Permit Fee Total 326.00 .00 .00 326.00
Plan Check Total 160.55 .00 .00 ,160.55
Grand Total 486.55 .00 .00 486.55
A
x
PrI �
Bin
•City, of La Quinta
Bullding-at Safety Division
P O. Box• tsN, 78-4.95 Calle Tampico
W Quinta, CA 92253 -'.(760) 777=7012 "
Lp r -z ILI. Building. Permit Application and. Tracking Sheet
Permit #
OS- 2q 28
Project Address: .591 S A'o-A ,(284 VI' LS
Owner's Name: S.A,v-(-A 6 5A LLO
A. P. Number:
Address: i(03 p�js��
Legal Description:
Address:(41
S
PContractor: CS
City. ST, Zip: FAX -1A) —RVay
FTelephoneJ —..Q 47 3 _
Project Description: foo Lj_57tl .4
City. ST. Zip:
9;)-03..!
bV l L/ / t1V(/
Telephone g80 -;Q0
.
State Lic. # : �,
City Lic. #:
Arch.. Engr.. Designer:
Address:
City, ST. Zip:
Telephone:.
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
CA PUSx
Sq. Ft.: a_Q
#Stories:
# Units.
Telephone # of Contact Person: 046 ` — 0-a0
Estimated Value of Project: cw (}o_
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
7l15/
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain.plan
Plans resubmitted
Mechanical
Grading plan
2nd Review. ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted'
Grading
IN HOUSE:-
'`" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A,I,p.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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STREET SWIMMING POOL PLAN FOR:
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JOB ADDRESS, SANTA ROSA TRAILS ICITY, LA QUINTA
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