05-2118 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property.,Address:
APN:
Application description
Property Zoninq:
Application valuation:
Applicant:
--!7 00002118 --!
79830 PARKWAY ESPLANADE
609-380-998-72 -293232
POOL - RESIDENTIAL
LOW DENSIT
Architect or
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I he eby affirm under penalty of perjury that 1 am lic nsed under provisions o .Chapter 9 (commencing with
coon 70001 of Division 3 of [he Business and ofessjonals Code, any icense is in full force and effect.
i
ate/'?_e, —Contract
OWNER -BUILDER DECLARATION
1 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 ($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.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to constructthe 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—) II am exempt under Sec. B.&P.C. for this reason
Date: 8j (��- Owner
CONSTRUCTION LENDING AGENCY
hereby affirmunder 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:
LQPERMTT
A
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/01/05
Owner:
---------------------------------
WILSON
79-830 PARKWAY
T.A QTTTTTTA , r'A
Contractor:
ESPLANADE NORTH
---------------------------------
MCINTYRE POOLS & SPAS, INC.
WCC: STATE FUND
WC: 1769111 01/01/06
Lic. No.: ---------------
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.
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 614611 1 09/30/08olicy Number C53
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 I should become subject tojjMe workers' compe tion provisions of Section
3700 of the Labor Code, I shall orthwrth dmply
with those isions.
oath` — 3 —G'Applican" ✓-, - / / �-,c,
WARNING: FAILURE TO SECURE WORKERS' OMPENSATION 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 Cuinta, 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.
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 building c nst tion, d hereby autho ' e representatives
of th/is/cpuiit4y to enter upon the above-mentioned propert r i pe/Ctio urposes.
Date: — J— mature (Applicant or Agent?/✓v
Application Number
05-00002118
Permit . .
BLDG POOL PERMIT
Additional desc
Permit Fee
207.00 Plan Check Fee
134.55
Issue Date
Valuation . . .
. 20000
Expiration Date
11/28/05
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
THOU M.DG 2;001-25;nnn
1152,00
Permit '.
MECH POOL
Additional desc '.
Permit Fee26.00
Plan Check Fee
6.50
Issue Date . . . .
Valuation.
0
Expiration Date
11/28/05
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
11/28/05
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
11/28/05
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 ONLY. ALARMS/BARRIERS SHALL .
LQPERMIT
..
-
Application Number . . . . . 05-00002118
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 1.59.80 nn
nn
1,59,80
Grand Total
470.80 .00
.00
470.80
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