05-2934 (RPL)10
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application, valuation:
Applicant:
�05c00002934
55088 LAUREL VALLEY
775-340-009- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
18000
Ti -&t 4 4 Q"
Architect or Engineer:
alVP�A&-Tor\,� - P I ry
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BRIGGS
VOICE (760) 777-7012
, FAX (760) 777-7011
INSPECTIONS (760) 777-7153
55-088 LAUREL VALLEY
n LA QUINTA, CA 92253
e U
O
JkJ . 18 2 05 Contractor:
CALIFORNIA POOLS & SPAS
C1TM OF LA WCC: SEABRIGHT INS
FrrNpNCE� WC: BB1050510 01/01/06
CSLB: 656128 10/31/06
LICENSE CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am Ii d under provisions of Chapter 9 (commencing with
Section 7000) of isio the Bus 'Hand P fess, nals Code, and my Lic sem%ff fP�� effect.
License Class: License No.: ��jJ LQa�IiC�
ate:1� '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 ($500).:
(_) 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 pioving 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
M
Date: 7/14/05
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 C8 C27 C29 C53 Poli nbeir
_ I certify that, in the performance of th rkN which this permit is issued, I shall not emp*f any
person in any manner so as to bNsuct
to the workers' compensation laws of California,
and agree that, if I shou becoa workers' compensationprovisions of Section
37 0 oof the Labor Co e, shall ly with those provisions.
&fixe: �� 5pplicant•
WARNING: FAILURE TO SECURE W RR ERS' COMPENSATION 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 nd void if work is not commenced
within 180 days from date of issuance of such permit, or ce s . of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above informati n , co rect. I agree to comply with all
city and county ordinances and state laws relating to buildin co struction, and reby authorize representatives
of unt to en r upon the above-mentioned property ,nspe n p rp e .
7y/
ate: nature (Applicant or Agentl:
Application Number . . . . 05-00002934
Permit . . . BLDG POOL PERMIT
Additional desc.
Permit Fee 189.00 Plan Check Fee 122.85
Issue Date Valuation 18000
Expiration Date 1/10/06
Qty Unit Charge Per Extension
BASE FEE 45.00
16.00 9.0000 THOU BLDG 2,001-25,000 144.00
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Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 1/10/06
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE >100K 11.00
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Permit . . . ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation 0
Expiration -Date 1/10/06
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
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Permit . . . PLUMBING
Additional desc .
Permit Fee . . . 33.00 Plan Check Fee 8.25
Issue Date Valuation . . . . 0
v Expiration Date 1/10/06
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
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Special Notes and Comments
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
LQPERAIIT
LQYERDiIT
Application Number . . . . . 05-00002934,
r
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Special Notes and Comments
ti
BE IN PLACE PRIOR TO PRE -PLASTER
S
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid
-------------------------------------
Credited
--------------------
Due
Permit Fee Total 293.00 .00
.00
293.00
Plan Check Total 148.85 .00
.00
148.85
Grand Total 441.85 .00
.00
441.85
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