05-2704 (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:
�05-00002764
\78860 -CITRUS
772-101-010- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
17000
Tit!t 4 4a Q"
Architect or Engineer:
rk,4 C- To A/A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CO ACTOR'S DECLARATION
I hereby affirm under penalty,of perjury that I am licens n provisions of Chapter 9 (commencing with
Section 7000) of i io he Business and Professi Is de, and m is' I e and effect.
Lice se Class: is se No.: �-S
ate: � � Contractor:
.. OW •BUILD DECLARATION
I hereby affirm under penalty of perjury that I am exempt m 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, 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.).
(_ 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 this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPER111IT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/01/05
Owner:
CAPITAL PACIFIC HOLDINGS
4100 MACARTHUR BLV STE 200
NEWPORT BEACH, CA 92660
Contractor: —�--
CALIFORNIA POOLS & SPAS
WCC: SEABRIGHT INS
WC: BB1050510 01/01/0 _
CSLB: 656128 10/31/0 fi 2005
CITY OF IA QUIIdTA
WORKER'S COMPENSATION DECLARATION
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.
XI 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: �/// /
any
person in any manner sbject to the workers' compensation laws of California,
and agreeICRIINAL
t to the ers' compensation provisions of Section
3 00 of trt co with [hose provisions.
77
gate: 6/ App
WARNING: FAILURE TO ATION with
IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYERNALTIES 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 Ouinta, 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 v id if w is not commenced
within 180 days from date of issuance of such permit, or ces tion f work or 180 days will subject
permit to cancellation.
I certify that I have read this application and state that thea ove informat� is corre I agree to comply with all
city and county ordinances and state]mor
ing to b ' ing constructi6n, and herr uthorize representatives
of this court y to ter upon the aboved pro rty f insper• '6n p r sus.
Dat . ignature (Applient .
Application Number . . . . . 05-00002704
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
180.00 Plan Check
Fee
117.00
Issue Date . . . .
Valuation
. . .
. 17000
Expiration Date
12/28/05
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
12/28/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000.EA
----------------------------------7-----------------------------------------
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 . .
12/28/05
- 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
7.50
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
12/28/05
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 & WATERFEATURE.
LQPERMIT
Application Number . . . . . 05-00002704
----------------------------------------------------------------------------
Special Notes and Comments
ALARMS/BARRIERS SHALL 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 142.25 .00 .00 142.25
Grand Total 426.25 .00 .00 426.25
LQPERMIT