05-3013 (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:
05-00003013
43469 PARKWAY ESPLANADE W
609-380-997-32 -293233-
POOL'- RESIDENTIAL
LOW.DENSITY RESIDENTIAL
20000
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or
-----------------------------
LICENSED CONTRACTOR'S
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3. of the Business and Professionals Code, and my License is in full force and effect.
License Class: c License No.:
-"'Date: bri Contract
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that) am exempt from the Contractor's State License Law for the
following reason (Sec.7031�.5, Business and.Professiohs 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 ds licensed pursuant t6 the provisions of the Contractor's State
License Law mme
(Chapter 9 (concing with Section 7000) of Division 3 -of the Business and Professions Code) or
that he or she is'exempt therefrom and•thebasis for the alleged -exemption. Any violation of Sectioh�7031.5by
any applicant for a'permn subjects the applicant tc a.civil penalty,of not more than five hundred dollars ($500).:
( _ ) I, as owner: of the property, or my employees with wages as their sol ecompensation, 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, provide&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 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
Date: 7/19/05
Owner:
TASZAI, DAWN
43-469 PARKWAY
LA QUINTA, CA
LA QUINTA, CA
ESPLANADE W
92253
Contractor:
ALPINE SERVICES
WCC: STATE FUND
WC: 2290023236`. Q1/01/06
CSLB: 786324 10/31/06
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 ofahe Labor Coder for the performance ofthe work for which this permit is
issued:_ '
I have and will mainjain 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 carrierarid policy numberare:
Carrier C53 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 that, if 1 should become subject to the workers' compensation provisions of Section
3700'of the Labor Code, Code, I 1 s fo t mply with those provisions.
a . h5 Applic3tft:9
WARNING: FAILURE TO SECURE:WORKERS' COMPENSATION COVERAGE ISUNLAWFUL, AND SHALL
SUBJECT AMEMPLOYER TO CRIMINAL PENALTIES ANDCIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). ,IN ADDITION TOTHE 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 actor omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as aresult 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 to5��?p
d hereby authorize representatives
of th' .. tty7to e7nter upon the above-mentioned orposes.
t�7/ uW6 Signature (Applicant or A nt):
Application Number .
. . . . 05-00003013
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit -Fee.''.
207.00
Plan Check Fee
134.55
Issue Date...
Valuation.
20000
Expiration Date
1/15/06
Qty Unit Charge
Per
Extension
BASE
:FEE
45.00
18'.00. 9.0000
THOU. BLDG
2,001-25,,000
162.00
Permit MECH POOL
Additional desc .
P.ermit'Fee
26.00
Plan Check Fee
6.50
" Issue Date
Valuation
0
Expiration Date
1/15/06
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 ..
Additional
Permit:Fee
45.00
Plan. -Check. Fee
11 .25 '
Issue DateValuation
0 '
Expiration Date ..
T•/15./,06
- 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 'Pee
33.00
.. Plan Fee
8.25
Issue Date
.Check
Valuation.
0
Expiration Date
1/15/06
Qty' Unit Charge
Per
Extension
BASE
FEE
15..00
2.00 6.00,00
EA PLB
FIXTURE
12.00
1.00 3.00.00
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
LQPERMTT
Application Number . . . . . 05-00003013
----------------------------------------------------------------------------
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
LQPERMIT
'Total -Permit 1.ces
Binl
-0
City Of9U,
111td
Building &r Sa[e;ty'Division
Permit #
P.O: Box 1504, 78495 Calle,-Tampico .
057— 3o/,3
La Quinca, CA 92253. 777-7012'
Project
BuildinPermit
g. _ Application MTracking Sheet
"`
Address:
k
kK ES .C�1nrq iS1
Owner's Narnc:
A. P. Number:
Legal ;Description:
Address-'
_ ,
Contractor: � �
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City, ST, Zip':': _
. :... ,
Telephone;
r
Address:
e ss:
t7x� Q%
City, ST, Zip:V
,Project Description:
66 / S ✓1
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/ a
Telephone: 1/ -a 3 5�
3
State;;::;::»><::::::>
3 a.
„City Lic. N
Arch., Engr., Designer:
6.u
.
Address:
City, ST, Zip:
.
Telephone:
State' Lic. #:
.0 on stni cti n�
oT•
' 3 Pc: upancy:
Narne.oCContact Person:
►�
^�-
Project t �P . ,(n_ rel cone dd'
n Alter Repair Demo
_
Telephone # of Contact Person:
•1 Vl1Fi ► 1
�' ��5
Sq. Ft.:
# Stories•.
ay Units:.
Estimated Value of Project:
APPLICANT DO NOT WRITE BELOW THIS'LINE
q
Submittal
Req'd
Recd
TRACKING'
Plan Sets
Plan Check submuted
PERMIT FEF S
Structural Calcs.
,.
Reviewed, ready for
71.'g/p
Item
Amount
.
Trusr'Calcs.
corrections
.Called Contact Person c:
Plan Check Dcposit
Title T4 Calcs..
=
=
Plan Check Balance
Plans,Picked up
Flood plain plan
Construction
Plans resubmitted
Grading plan
'
hlichanicat
Subcontactor List
2"'.RevicK, ready for corrections/issue
Electrical
Called Contact Person
Grant Deed
rians.p cked up
Plumbing
H.O.A. Approval
S.M.I.
Plans. resubmitted
IN HOUSE.-
Grading
Planning Approval
'.. Revie ` eady for cor rectwns/issu'e
Developer Impact Fee
Callcd Contact Person'
Pub..Wks. Appr
A.f.P.P.
Date of permit issue
School Fees
'Total -Permit 1.ces