04-7418 (RPL)IV
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 00.4-0.006_7418
Property Address:
57851 SANTA ROSA TR
APN:
762-240-013-5 -30487 -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
22000
4�VOICE 760 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Owner:
SANTA ROSA DEV
40847 SANDPIPER CT
PALM DESERT, CA 92.260
r
1 Contractor:
Applicant: Architect or En U� .0 1 005 CASA VERDE LANDSCAPE MAINT COR
78341, DARBY ROAD
OF 1� IDEp INDIO, CA 92203
(909) 590-2425
Lic. No.: 624647
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.
LicennsseClass: C-27 1 UcenseNo.: 624647
.
a: C� Contracts V(_
OWNER -BUILDER DECLARATION
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).:
(_ 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—) 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
Date: 5/25/05
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 GRANITE Policy Number 9549987
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
r/ 00 of the Labor Code, I shall forthwith comply with those provisions.
Date: T Applicare? rC/
<L V L
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 ($100,0001. 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 that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, a�_epresentatives
of this u//n///�`qqq'''�% to nter upon the above-mentioned pro/pe/ray for inspection pur
Date: $' &&5 Signature (Applicant or AgentlY
Application Number . . . 04-00007418
Permit . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
225.00 Plan Check
Fee
146.25
Issue Date . .
11/23/04 Valuation
. . .
. 22000
Expiration Date
5/23/05
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 . . . .
11/23/.04 Valuation
0
Expiration Date
5/23/05
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 Fee . .
45.00 Plan Check
Fee
11.25
Issue Date . . . .
11/23/04 Valuation
. . :
. 0
Expiration Date
5/23/05
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 . . . .
11/23/04 Valuation
0
Expiration Date
5/23/05
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 & SPAS. ALARMS/BARRIERS SHALL
LQPERMIT
Application Number . . . . . 04-00007418
----------------------------------------------------------------------------
Special Notes and Comments
BE IN PLACE PRIOR TO PREPLASTER
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
0
LQPERDtIT
P.O. Box 1504
78-495 CALLE .TAMPICO
LA QUINTA,' CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).'777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application,Number .
. . . . 04-00*007418 Date 11/23/04
Property Address . .
. . . . 57851 SANTA ROSA TR
APN:
762-24*0=013-5 -30487 -
Application description . . . POOL - RESIDENTIAL.
Property Zoning . . .
. . . . LOW DENSITY RESIDENTIAL
Application valuation_22000
Owner
Contractor,,,',
SANTA ROSA DEV
DIAMOND CREEK POOLS
40847 SANDPIPER CT
78341 DARBY ROAD
PALM DESERT
CA 92260 INDIO
CA 92203-
2203(909)
(909)590-2425
WCC: STATE FUND.
WC: 1776208
02/10/05
CSLB: 585287
01/31/06
CCC: Bl -C53 -C27
Permit MECH POOL
Additional desc
Permit Fee . . . .
24.00 Plan Check Fee
6.00
Issue Date . . . .
Valuation
0
Expiration Date
11/23/05
Qty Unit Charge
Per
Extension
1.00 9.0000
-----------------------------------------------7----------------------------
BASE FEE.
EA MECH "FU•RNAOE <=100K -''"''
15.00
`"`` 9.00
Permit . . . . .
BLDG POOL PERMIT
Additional desc
Permit Fee
225.00, P1=
;;—_Che= —Fee "°, 146.25
Issue Date . . . .
'V.a
.'u) tion' 0
22000
Expiration Date
11/23/05
Qty Unit Charge
Per
Extension
BASE FEE
45.00
20.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,
000 dg�F��
180.00
Permit . . . . . .
ELEC POOL PERMIT -RES
Additional desc
Permit Fee . . . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
11/23/05
Qty Unit Charge
Per
Extension
BASE FEE
- _ 15.00
1.00 30.0000
EA-.. -`�� EI;E�C ;PRIVATE_"SWIMMING POOL
`��'` "3,0. 00
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: b 7
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's
Lic. No.:
BUILDING PERMIT DECLARATIONS
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 7.77-7153
Date:
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 i in full force and effect.(
License Class _—.S_ License No.
Dateill L Contractor_ fjy%d A � �Q Q � V6 a
OWNER -BUILDER DECLARATION
1 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 for a 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 Owner
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.
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
ss d. My worker ' compensation insurance carrier and policy number are:
Carrierll, Policy Number 1 7) Cage
_ 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 th should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
�1
forthwith comply with those provisions.
Date Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSAT 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
Lenders Name
Lenders Address
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. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter upon o -mentioned property for inspection purposes.
�� Ut
Date Signature (Applicant or Agent):
Page 2
Application Number .
. . . .
04-00007418
Date 11/23/04
Permit . . . . . .
PLUMBING
Additional,desc
Permit Fee . . . .
33.00
Plan Check Fee
8.25
Issue Date . . . .
Valuation . .
. . 0
Expiration Date
11/23/05
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..0.000
--------------------------------------------------------------------------------
EA PLB
GAS PIPE 1.-4 OUTLETS
3.00
Special Notes and Comments
POOL & SPAS. ALARMS/BARRIERS SHALL
BE IN PLACE PRIOR TO
PREPLASTER
INSPECTION. EQUIPMENT
ENCLOSURE
NOT
INCLUDED IN PERMIT.
Fee summary Charged
Paid Credited
Due
Permit F&e Total
327.0.0
.00 .00
327.00
Plan Check Total
171.75
.00 .00
171.75
Grand Total
498.7.5
.00 .00
498.75
-
_ - ----- __ ! --------- --__ _ �_ __� 1_- �-
1
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