04-6802 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: E04-00006802�x
Property Address: 5781:0—SANTA OSA TR
APN: 762-240-013-28 -30487 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 22000
Tit!t
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner
SANTA ROSA DEV
40847 SANDPIPER CT
PALM DESERT, CA 92260
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/25/05
(_ 1 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.).
(_ 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.).
(_) I am exempt under Sec. , BAP.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
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 ($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 1 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�thorize representatives
of t/hiis�couunn'tyyjo a ter upon the above-mentionedy, pro/pe/rafo pecvo rp:ses.
/)
Date: fr / Signature (Applicant or Agent):/
r
Applicant: Architect or En e : j1 ►A1 J
Q 1 (,00C
Contractor:
CASA VERDE LANDSCAPE MAINT COR
JUI`�
78341 DARBY ROAD
��iIIFYtQ+
CISt)FP7.
f C
INDIO, CA 92203
(909) 590-2425
LiC. No.: 624647
' LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby
affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and, Professionals Code, and 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: C-27 License No.: 624647
Date: Contractor• ��
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
y 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier GRANITE Policy Number 9549987
following reason (Sec. 7031 .5, Business and Professions Code: Any city orcounty 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 so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
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).:
700 of'the Labor Code, I shall forthwith comply with those provisions. ,
�/jo I
a� te: p Applicant:,.," C_V
(_ 1 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.).
(_ 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.).
(_) I am exempt under Sec. , BAP.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
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 ($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 1 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�thorize representatives
of t/hiis�couunn'tyyjo a ter upon the above-mentionedy, pro/pe/rafo pecvo rp:ses.
/)
Date: fr / Signature (Applicant or Agent):/
r
Application Number
. . . 04-00006802
Permit"
BLDG POOL PERMIT
i Additional desc .
Permit Fee . .
225.00 Plan Check Fee
146'.25
Issue Date . . . .
10/18/04 Valuation . . .
. 22000
Expiration Date
4/17/05
Qty Unit Charge
Per
Extension
BASE FEE
45.00
20.00 9.0000
------------------------------------------
THOU BLDG 2,001-25,000
----------------------------------
180.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee
24.00 Plan Check Fee
6.00
Issue Date
10/18/04 Valuation . . .
. 0
Expiration Date
4/17/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
-----------------------------------------------------------------------------
EA , MECH FURNACE <=100K
9.00
Permit . . ELEC POOL PERMIT -RES
Additional desc
Permit Fee45.00
Plan Check Fee
11.25
Issue Date . . . .
10/18/04 Valuation . . .
. 0.
Expiration Date
4/17/05
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 . . . .
10/18/04 Valuation . . . .
0
Expiration Date
4/17/05
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. ALARMS/BARRIERS SHALL BE IN
LQPER M
Application Number . . . . . 04-00006802
.----------------------------
Special Notes and Comments
--- -----
PLACE AT PRE -PLASTER INSPECTION•.'
EQUIPMENT ENCLOSURE NOT INCLUDED IN
PERMIT.
**PERMIT REPRINTED TO REFLECT CHANGE OF
CONTRACTOR. $4.50 SUPPLEMENTAL FEE
CHARGED.
-------------------------------------------- ------------------------
Other Fees . . . . . . CHANGE OF CONTRACTOR
---
4.50
Fee summary Charged Paid
Credited
Due
-- ----------
Permit Fee Total 327.00 327.00
---------- ---------
.00
.00
Plan Check Total 171.75 171.75
.00
00
Other Fee Total 4.50 .00
.00
4.50
Grand Total 503.25 498.75
.00
•
4.50
LQPERMIT
Sent By: AMPAM-LDI;
INSTALLATION CERTIFICATE
57-810 Santa Rosa Trail
909 340 9688; May -12-05 8:49; Page 9/19
Permit #
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form
is required; however, use of this form to provide the information is optionl.) After completion of final inspection, a copy must be provided to the building
department (upon request) and the building owner at occupancy, per section 10.103(b).
HVAC SYSTEMS:
# of
Effecieney
Duct
Healing Equipment
(pkg. heat
CEC Certified Compressor Unit
Identical
(SEER, etc)'
Location' .
Equip. Type
# of
Efficiency
Duct
Duct or
Heating Heating
(pkg. heat CEC Certified Mfr, Make &
Identical
(AFUE,etc.)'
Location
Piping
Load Capacity
pump, etc.) Model Number
Systems
[aCF-1R value)
(attic etc.)
R -value
(Btu/hr) (BTU/Hr)
FAU CARRIER 58STX 110122
1
80.0%
ATTIC
R4.2
110,000
FAU CARRIER 58STX090116
1
80.0%
ATTIC
R4.2
90,000
Cooling Fgnipmem
Equip. Type
# of
Effecieney
Duct
Cooling Cooling
(pkg. heat
CEC Certified Compressor Unit
Identical
(SEER, etc)'
Location' .
Duct
Load Capacity
pump, etc.)
Mfr. Name and Model Number
Systems
[2:CF-1R value)
(attic etc.)
R -value
(Btu/hr) (BTU/Hr)
A/C COND.
CARRIER 38BRC060000
1
12
ATTIC
R4.2
60,000
A/C COND.
CARRIER 38BRC048000
1
12
ATTIC
R-4.2
48,000
1 2 reads greater than or equal to.
1, the undersigned, verify that the equipment listed above is: 1) is the actual equipment installed, (2) equivalent to or more efficient than that specified in the
certificate of compliance (Fors CF -IR) submitted for compliance with the Energy Efficiency Standards for residential buildings, and (3) equipment that meets
or exceeds ropriate requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable.
AMPAM LDI Mechanical
Jennifer 5/11/2005 HVAC Subcontractor (Co. Name)
OR General Contractor OR Owner
WATER HEATING SYSTEMS:
Water CEC Certified Distribution If Recir- Rated Input Tank Efficiency Standby Extcmal
Heater Mfr Name & Type (Std, culation, # of Identical (kW or Volume (EF, RE) Loss (%) Insulation R -
Type/# Model Number Point -of -Use) Control Type Systems Btuft) (gallons) value
FAUCETS & SHOWER HEADS:
All faucets and showerheads installed are listed in the Commieions Directory of Certified Faucets and Showerheads,
pursuant to Title -24, Part 6, Subchapter 2, Section 111.
1, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment installed and that the equipment meets or exceeds
the requirements of the Appliance Efficiency Standards. In addition, I have verified that the equipment is equivalent to or more efficient than the equipment
specified on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for residential buildings.
Signature, Date
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
RCR COMPANIES
Plumbing Subcontractor (Co. Name)
OR General Contractor OR Owner
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 4 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777,-7153
BUILDING PERMIT
Application Number-'.
Property Address . . . . . .
APN:
Application description . . .
Property Zoning . . . . . . .
Application valuation
Owner
------------------------
SANTA ROSA DEV
40847 SANDPIPER CT
PALM DESERT CA 92260
04-00006.8.0.2 Date 10/18/04
( _5_7810 SANTA ROSATR }
762-240-013-28 -30487 -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
22000
Contractor -
D°
2QQ4
Permit - . ---
"A1JITCfTY®�nPA --
Perm------ �1N�NBLD-GITPOOL
Additional d
Permit Fee . . . . 225.00
Issue Date
DIAMOND CREEK POOLS
78341
DARBY ROAD
INDIO
CA 92203
(909)
590-2425
WCC:
STATE FUND
WC:
1776208
02/10/05
CSLB:
585287
01/31/06
CCC:
B1 -C53 -C27
ERMIT
Plan Check Fee 146.25
Valuation . . . . 22000
Qty Unit Charge Per Extension
BASE FEE 45.00
20.00 9.0000 THOU BLDG 2,001-25,000 180.00
Permit . . MECH POOL
Additional desc
Permit Fee . . . . 24.<.00 Plan Check Fee 6.00,
Issue Date . . Valuation 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 9.0000 EA MECH FURNACE <=100K 9.00
----------------------------------------------------------------------------
Permit . . . . . . ELEC POOL PERMIT -RES
Additional desc
Permit Fee . . . . 45.00. Plan Check Fee 11.25
Issue Date . . . . Valuation . . . . 0
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
P.O. BOX 1504 • VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
n
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
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 Licenses in�ull force and effect.
/^ S��
X%nse Class % \ icense No. e,( / P
�Date �� Z-0 Contractor 1�1 C�Vhs� h (t t fC • . d .
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 fora permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' 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.
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
N
My rkers' compensation in ce carrier and isYY numb are:
arrier N t olicy Number � C -V 7
I certify that, in he performance of the work for which this pe s� sue 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 shall
forthwith comply with those provisions.
/Date O icant \,, Cl .
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 ($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.
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 IF
Lender's Address AFt
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 that the above information is correct. to comply with all city and county ordinances and state laws relating to building
construction, an41herleby authorize re esentatives of this county to enter upon the ove-menti red property for inspection purposes.
/Date �a Signature (Applicant or Agent):
Page 2
Application Number 04-00006802
Date 10/18/04
Issue Date . . . .
Valuation . .
. 0
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 INS.T/ALT/REP
3.00
1.00 3.0000 EA PLB
GAS; PIPE 1-4 OUTLETS,.3.00
---------------------------------------------------------------
Special Notes and Comments
`
POOL/SPA. ALARMS/BARRIERS-SHALL
BE IN
PLACE AT PRE -PLASTER 'INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged
Paid Credited
Due
Permit Fee Total- 327.00
00 .00
327.00
Plan Check Total 171.75
.00 .00
171.75
Grand Total 498.75
.00 .00
498:75
__ ----- -- -- .-- - ___ � __. _ _ --- _ _ _____ -- ---_ L
__