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11-0362 (RPL)P.O. BOX 1504' , 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 9225.3 Application Number: 11-00000362 Property Address: 50944 VIA ANCANTARA APN: 772-250-018-24 -31349'- Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application .valuation: 18060 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: ART & BARBARA FORSYTH 50944 VIA ANCANTARA LA QUINTA, CA n VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 U 1 Contractor' Applicant: Architect or Engineer: Date: 4/11/11 LQPERMIT l 8 20� 1 PICAS POOLS I®J, 42335 WASHIN O f PALM DESERT, 92 �� A �UIN (. Olt (760)345-460'" Lic. No.. 810111 - . LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of.Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided - License Class: B C27 C53 License No.: 810111 for by Section 3700 of the Labor Code, for the.performance of the work for which. this permit is issued. ate: ( 1 Contractor: — Ll have and will maintain workers' compensation insurance, as.required by Section 3700 of the'Labor I Code,. for the performance of the work for which this permit is issued. My workers' compensation OWNER -BUILDER DECLARATION insurance carrier and policy.number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE 'FUND Policy Number :i960476 ' following reason (Sec. 7031 .5, Business and Professions Code:' Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any ' construct, alter, improve, demolish, or. repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he -or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section - License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I hwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for apermit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: plicant: 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL ' Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND - and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN ' 'improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST,,AND ATTORNEY'S FEES. - - 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.). - APPLICANT ACKNOWLEDGEMENT ( _ ) as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. - IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. - - t,and property who builds or improves.thereon, and who contracts for the projects with a contractor(s) licensed, 1. Each person upon whose behalf this application is made, each person at whose reque for , pursuant to the Contractors' State License Law.).. - whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1 _ 1 I am exempt under Sec. • B.&P.C. for this eason 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 actor omission related to the work being' performed under or following issuance of this permit. Date: - Owner: 2 Any permit issued as a result of this application becomes null and void if woik is not commenced within 180 days from date of issuance of such permit, or cessation of. work for 180 days will subject - CONSTRUCTION LENDING AGENCY permit to cancellation. - I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinances and state laws relating to building construction, and hereby authorize representatives 'oft ' co my to enter upon the above-mentioned property for i s n purposes. ' Lender's Name: _ Date: S' ature (Applicant or Agent): - Lender's Address:Pik - `. r LQPERMIT Application -Number 11-00000362 Permit BLDG POOL PERMIT Additional desc Permit Fee 189.00 Plan Check Fee 122.85 Issue Date Valuation 18000 ' Expiration Date 10/08/11 Qty _ Unit Charge Per Extension BASE FEE 45.00 16.00 =,-.9.0000. THOU BLDG 2,001-25,00,0 144..00 Permit MECH POOL. Additional' desc . Permit Fee 26.00. Plan Check Fee 6.50 _Issue Date Valuation 0 Expiration.Date 10/08/11 Qty Unit Charge Per Extension 'BASE FEE 15.00 " 1.00 11.0000 EA MECH FURNACE >100K. 11.00 Permit . . 'desc ELEC•POOL PERMIT -RES" Additional : Permit Fee 45.00 •Plan.Check,Fee 11.25 Issue Date . . . . Valuation 0 Expiration Date .: 10/08/11 Qty Unit Charge Per. Extension BASE FEE" • 15. 00" 1..00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.0.0, Permit PLUMBING Additional desc . Permit Fee 27.00 Plan Check Fee 6.75 Issue Date . . . . Valuation 0 Expiration Date 10/08'/11 Qty Unit Charge Per Extension BASE FEE 15.00. 1.00 6.0000 EA PLB FIXTURE 6.00 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- .. LQPERMIT Application -Number 11-00000362 i Permit. WALL/FENCE PERMIT Additional desc . • Permit Fee 15.00 Plan Check Fee.. .00 Issue Date Valuation 64 Expiration Date... 10./08/11 Qty Unit Charge Per Extension BASE FEE 15..00 Special Notes and Comments . POOL, 4 L.F. 4' EQUIPMENT ENCLOSURE, CITY STANDARD. ALARMS/BARRIERS SHALL, BE IN PLACE AT PRE -PLASTER INSPECTION. 2010 . CODES: ----------------------------------------------------------- Other Fees BLDG STDS ADMIN (SB1473) -------------- 1.00. Fee summary Charged Paid Credited'. ---------- Due, Permit-Fee Total 302.00 .00 .00 302.00 Plan Check Total 147.35,. .00 :00 147.35 Other. Fee Total 1.00 00 00 1.00 ' Grand Total 450.35 :00 ..00 450.35 flennk # Adm --s: 7P. —Nmn6C-- L4 14 (v c city Of. L2 Q uin-'t2 B Luldmg. ff Saf e,_y Dhisioi-I P. 0. BOX 15044, 78-51 -F-S. Cape Ta nIpj= 10 Quina, CA 9225; - (700) 777.70 Building Permit AD plication and Trackiha Shee:, %vnes x1aMIC! 44 Lf �jA CMS Kcir". : == D=scnv MProi L I Or%, Lir- 05C) Addt S-. al: Tci-phonc: Total Pcmiff,, COPs';Tu-6on Ti -P Smtc Lic. PrRlc-- r"Pt (cir- de one): Ncw Atid n R- ZP Contac Peon: Storiesof &45-4!2DO APPLJCANT: D10 NOT WRITE BELOW Submi mj THIS LINE P—,'d Plan sez, P1211 CtIC::J, SUbmimd PZR!4TTj FEES . I Snv=urai Calm Rwime(L reads for. corrections 'AM.Oun( Truss C.21 P!2M Chock D,,,S, Called COM20 prrson Titk 2�1 Calm Plan Check. P";:..,2nCC FIRM Pickrd UP "Flood plain plan Consrruction Plans rcmubmirtcj -Gr2diq P12n SUb4Wn'=CIGr Rclinv. rc2dy for Corr,-Crio nsassue T—W Called Contact PC,- son `Grznl De --d ' P.2MS picL. d Up *PLzRs rtsubmined Gmdin- re2d,,. for CDrrtrrion . Si-ISSOC 'I'lanniq Aj peo,al I DeveloperInIRO Fcr Called Con.tac, person -Pub. Wk&.Appr I .-1-P.P. Da cc of permit issue Total Pcmiff,, 1 -7 - I I - -- - 0