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05-2681 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: X05-00002681 Property Address: 78850 CITRUS APN: 772-101-011- - - Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 17000 Applicant: Architect or Engineer: 0FOP AIA BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CO RACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am lice d u er provisions of Chapter 9 (commencing with Section 7000) of ion a Business and Profes nal Code, and my �e . i f goend effect. License Cla s: cense No.: f�pv� C9[ Es - OWNER -B R 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).: (_) 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 (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. , 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 Owner: CAPITAL PACIFIC HOLDINGS 4100 MACARTHUR BLV STE 200 NEWPORT BEACH, CA 92660 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/30/05 Contractor: Et6 CALIFORNIA POOLS & SPASWCC: SEABRIGHT INS WC: BB1050510 01/0L J v 2505CSLB: 656128 10/3oFcgQ1NP�r..__ r<1 ------------------ WORKER'S ----------------- 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 C8 C27 C29 C53 Pol' umber - - _ I certify that, in the performance of a or r which this permit is issued, I shall not employ any person in any manner so as to b o e sub' ct to the workers' compensation laws of California, and agree that, if I should become bject o the workers' compensation provisions of Section 37 of the Labor C e I shall ort comply with those provisions. atH te: �JAppP c..,--,/ 4-, WARNING: FAILURE TO SECURE PIKERS' 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 f work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above informa is torr t. I agree to comply with all city and county ordi antes and state laws relating to build' onstructi , a h by authorize representatives of this c nt toe a the above-mentioned grope fo insp io pur D ignature (Applicant or Agent) Application Number . . . . . 05-00002681 Permit . . . BLDG POOL PERMIT Additional desc . . Permit Fee . . . . 180.00 Plan Check Fee 117.00 Issue Date . . . . Valuation . . . . 17000 Expiration Date 12/27/05 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*. . 12/27/05 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 12/27/05 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 . . . . Valuation . . . . 0' Expiration Date 12/27/05 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 ONLY. ALARMS/BARRIERS SHALL LQPERMIT Application Number . . . . . 05-00002681 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 LQPERDSTT