05-2864 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05=00002864-1
Property Address: 57654 SANTA ROSA TR
APN: 762-240-013-23 -30487 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 20000
Applicant:
eolV 7X4 C,7_0
Architect
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
ca a
or
JUL 2 0 2005
CITY OF LA QUINTA
FINANCE DEPT.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am 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 force and effect.
License Class: License No.:
ate: Contractor:�
��P*'�
OWNER -BUILDER DECL_ARR'AATI`ON,
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).:
(_) 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.). -
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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 contractorls) 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:
LQPERAIIT
Owner:
SANTA ROSA DEV
40847 SANDPIPER CT
PALM DESERT, CA 92260
Contractor:
CASA VERDE LANDSCAPE
WCC: GRANITE
WC: 9549987
CSLB: 624647
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
MAINT COR
09/05/05
08/31/06
Date: 7/11/05
-----------------------------------------------
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 C-27 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
3/7000 of the Labor Code, I shall forthwith comply with those provisions.
ate: j Applican&-
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 1$100,000). 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.
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, 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 [ t the above information is correct. I agree to comply with all
city and c uhty ordinances and state laws relatin o building construction, an by authorize representatives
of thi ounty to enter upon the above -mention property for inspection poses.
te: Signature (Applicant or Agent):
J
Application Number . . . . . 05-00002864
Permit BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 207.00
Plan Check
Fee
134.55
Issue Date . . . .
Valuation
. . .
. 19792'
Expiration Date 1/07/06
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 1/07/06
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
Expiration Date 1/07/06
Qty Unit Charge Per
Extension
_ BASE FEE
15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL
--------------------------------------------------------------
30.00
--------------
Permit . . WALL/FENCE PERMIT
Additional desc-.
Permit Fee . . . . 15.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 208
Expiration Date 1/07/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
------------------------------------------------------------------------=---
Special Notes and Comments
POOL & SPA ONLY. 13 L.F. 4- EQUIPMENT
l BLOCK WALL, CITY STANDARD.
ALARMS/BARRIERS SHALL BE IN PLACE PRIOR
TO PRE -PLASTER INSPECTION.
LQPERMIT
LQPE"IrT
Application Number
. .
05-00002864
Fee summary
Charged
Paid
Credited
Due
-------
Permit Fee Total
----------
293.00
----------
.00
---------- ----------
.00
293.00
Plan Check Total
152.30
.00
.00
152.30
Grand Total
445.30
.00
.00
445.30
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Permit #05 - 2 86
City of La Quinta
Building at Safety division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (160) 777-7012
Buildinh Permit Annliratinn !knA
Project Address: s?4Sl f S &'Q'rA
12gsq -VANS
Owner's Name: -9,v-(-A A9A T9 94
I L�
-�/ t� n
A. P. Number:
TRACKING
Address: /Cos /M
M� �,�
Legal Description:
Plan Sets
City. ST. Zip: EA)CIN 1M -C CA 9aoay
Contractor::. CAS
FTelephone X _ O 92
�• �.
Address: -'?—L3(4h
Project Description: e00 Lv? d. �/.�, 7 1/9 -
City. ST. Zip:
-1 3
W /7 C �" &� C, 77--Z- �,,,),gv,2i
�nfaco
ephon 990`x-03
t'3 LF (f I
eLic.p: 6 c-���
L
Cin• Lic.:h..
Engr.. Designer:
Called Contact Person
Address:
`
City. ST. Zip:
Enemy Calcs.
Flood plain plan
Telephone:
Plans picked up
Plans resubmitted
Construction Type: Occupancy:
State Lic. it:
Name of Contact Person: A L CAM
Project type (circle one): New Add -n Alter Repair Demo
iPV—�
Sq. Ft.: g-vo 4 k Stories: R Units:
Telephone # of Contact Person:
XEslimaled Value of Project:
APPI MANT- nn ntnT wnivr- I
X08
Iq
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Z
Plan Sets
Pian Check submitted
ltttn
Amount
Structural Caics.
Reviewed. ready for corrections
Plan Check Deposit
Truss Coles.
Called Contact Person
Plan Cheek Balance
Enemy Calcs.
Flood plain plan
Plans picked up
Plans resubmitted
Construction
Mechanical
Grading plan
V Review. ready for corrections/issue
Electrical
Suhcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAM.
!
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Planning Approval
Pub. Wks. Appr
School Fees
"' Review. ready for corrections/issue
Called Contact Person
Date of permit issue
Developer Impact Fee
A_I•P.P.
Total Permit Fees
X08
Iq