05-2683 (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_n0�0002683,
*78880 CITRUS
772-1017008- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
17000
(� N TRA C- 7-0 /�
Tit�144Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I a d under provisions of Chapter 9 (commencing with
Section 7000) of io the Business and ofessi nals Code, and mDBA/ i i orce and effect.
License Class: License No.: py E7 ( C.i
V bete: Contractor:
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 (55001:
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.).
(_ 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
CAPITAL PACIFIC HOLDINGS D
4100 MACARTHUR BLV STE 200
NEWPORT BEACH, CA 92660
Contractor:
CALIFORNIA POOLS & SPAS
WCC: SEABRIGHT INS
WC: BB1050510 01/01/06
CSLB: 656128 10/31/06
Date: 6/30/05
.a a
JUL J � X005
CITY OF LA d$UIIYTA'
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
v issued.
/l I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
"Y77 Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are: 7workers'
Carrier CS C27 C29 C53 Poli umberI certify that, in the performance of the o for wit is issued, Iperson in any manner so as to bec m su ject compensation laws of California,
aydgree thatif I sho ecom subj c to thpensation provisions of Section
3of the Labor C e, shall f rth comprovisions.
te: �3z. licant:
WARNING: FAILURE TO SECURE W RKERS' COMP N 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 id if work is not commenced
within 180 days from date of issuance of such permit, or cess ion o ork for 180 days will subject
permit to cancellation.
I certify that 1 have read this application and state that the above infor tion i corr . I agree to comply with all
city and county ordinances and state laws relatin to buil ' cons ion, and y authorize representatives
a�of cou y "e�nter upon the above -mentis prope y f r inspect n pur S.
Rtgnature (Applicant or Agent):
Application Number ,. . . 05-00002683
Permit . . .
BLDG POOL PERMIT
Additional desc ..
Permit.Fee . . . .
180.00 Plan Check Fee
117.00
Issue Date . . . .
Valuation . . .
. 16920
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
Permit . . . . . .
WALL/FENCE PERMIT
LQPERMTT
Application Number . . . . . 05-00002683
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 15.00 Plan Check
Fee
.00
Issue Date .. . . . Valuation
. . .
. 80
Expiration Date . . 12/27/05
Qty Unit Charge Per.
Extension
BASE FEE
15.00
-------------------------------------------------------------------------=--
Special Notes and Comments
POOL, SPA & WATERFEATURE ONLY. 5 L.F.
4' EQUIPMENT BLOCK WALL, CITY STANDARD.
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 299.00 .00
.00
299.00
Plan Check Total 143.00 .00
.00
143.00
Grand Total 442.00 .00
.00
442.00
LQPERMIT