05-2944 (RPL)r'
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05 x00002944
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Property Address: 81590 TIBURON DR
APN: 767-531-002- - -
Application description: POOL - RESIDENTIAL'
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 200.00
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LTJ
AUG 01 2005
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS .(760) 777-7153
Date: 7/18/05
Owner:
MERRITT, WALTER
590 TIBURON DR
QUINTA, CA.92253
ontractor:
Applicant: Architect or Engineer:,_ CITY OF LA QUINTA NDIAN CREEK CONSTRUCTION
FINANCE DEPT. CC: EXEMPT
IC: EXEMPT 01/31/06
00 � /_CAG�� CSLB: 805577 03/31/06
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and P ofessionals Code, and my License is in full force and effect.
License Clasps: License No.:
gate 7'( &-J Comr ar:
�/ OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury tha 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 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 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:
LQPERI.IIT
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 A Policy Number - - - - - - - - - - - - - - -
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 thJLaboe,
b co a subject to the workers' compensation provisions of Section
3700 of the, forthwith comply with those provisions.
Dat ApplicWARNING: FAILURE TO SEKf S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 0100,000). IN THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LAINTEREST, 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 bui ing c tru ion, and hereby authorize representatives
of this cco/"ryy toenterupon the above-mentioned pro rw pe on purposes.
Date:? ' y� 7 Signature (Applicant or Agent): Y
'appIicatioo monbvez
05-00002944
` Permit . . . . . .
BLDG POOL'PERMIT
Additional deoo . .
Permit Fee
207.00 ^ Plan Check
ree .
. 134.55
Issue Date . . . .
Valuation
zoouo
Expiration Date . .
1/14/06
`
'
' Qty 'Unit
Per
Extension
BASE FEE
45.00
18`00 9.0000
---_----__-------------_--_-------------------_------_------_------_----
THOU BLDG 2'001-25'000
162.00
Pezmit . . . . . .
MECH POOL
`
Additional deoo
Pezmit.Fee . . . .
26.00. Plan Check
Fee .
. ' 6.50 -
Issue Date
Valuation
. . .
. ' o
Expiration Date . .
1/14/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
--'---------------------------------------------_---------------------------
EA MEcH rozauACE >zooK
11.00
-
germit . . . . . .
�
���c e0o� e�a�zr-ES
Additional 6eao . .
Permit Fee . . . .
45.00 eIao Check
Fee .
. 11.25
zoaoe Date . . . .
Valuation
o
Expiration Date ' .
1/14/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
----------------------------
EA ELEc eozvArE SwzommzmG
----_------------_---------_---------------_
eooL
30.00 '
eezmit ' . . . . .
eLDnm3ImG '
Additional deao . .
.Permit Fee
33.00 Plan Check
Fee .
. 8.25
Issue Date
Valuation
. . .
. O
Expiration Date -,.
1/14/06
Qty Unit Charge
Per
Extension
BASE FEE
'
15.00
2.00 6.0000'EA
PLB FIXTURE
T2.00
1.00 3.0000
oa PLB WArERZNST/ALT/ooe
a.00
. 1.00 3.0000
EA PLB GAG PIPE 1-4 OUTLETS
3.0,0
------------------------------------------- -------- ----------
Special and
_--�--__----
'
'
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
.
'
-
'
'
mPEUIIr
• it •
Application Number . . . . . 05-00002944
----------------------------------------------------------------------------
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 311.00 .00 .00 311.00
Plan Check Total 160.55 .00 .00 160'.55
Grand Total• 471.55 .00 .00 471.55
CITY OF LA
JOB ADDRESS J- q� -F1 PERMIT NUMBER
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. -11 L-_ ..,.,.+,,A .,., +k, ;^k a.,;+La +ham. Q..;I.;-- Incnor-tinn rnrel at all
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., INTA SUB -CONTRACTOR LIST
QlJ I OWNER WALE ER- M6P-121'T`► BUILDER J-rJDiA►•! �S�K Gomes, 2��T�o,I
times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
k d/ th oidance
on this job. • Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result In a stoppage of
wor an or e v
permit. For
ofbuilding' P
each applicable trade, all information requested below must be completed by
.............................................::.:.:.:::::::..................:..:::.::::...........................::::::::::::.::....................:....:.:.
applicant. "On File" is not an acceptable response.
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