06-3910 (RPL)ry
P.O.. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application. Number: -06=00003910
Property Address: 79835 -WESTWARD HO DR
APN: 649-061-006-6 -2190 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 35000
Applicant:
I hereby affirm under penalty ofperjur' that I ar
Section 7000) of Division 3 of the Bu nTs and
Licenses: 1053 i +���
Architect or Engineer:
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
AFRICA ROLAND
79835 WESTWARD HO
LA QUINTA, CA 922
Contractor:
INTERNATIONAL GUN
75153 MERLE DRIVE
PALM DESERT, CA 9
(760)034-1350
Lic. No.: 875547
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:y 11/07/06
5
NOV 13 2006
I C 0
UTEdftY0FLAQU1NTA
22 1 FINANCE DEPT
i CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
ensed under provisions of Chapter 9 (commencing with _ I hereby affirm under penalty of perjury one of the following declarations:
fessionals 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 No.: 875547 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
0 ER -BUILDER DECLARATION - insurance carrier and policy number are: '
I hereby affirm under penalty of perjury that a e empt from the Contractor's State License Law for the Carrier J WARLIN INS Policy Number 229003373006
following reason (Sec. 7031 .5, Busine an Professions Code: Any city or county that requires a permit to _ I certify that, in the pe ormance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or pa any structure, prior to its issuance, also requires the applicant for the person in any marine so as to ecome subject to the workers' compensation laws of California,
permit to file a signed statement that h or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I s uld beco a subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing Section 7000) of Division 3 of the Business and Professions Code) or , 3700 of the LgAor C G, I shall orthwith 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 a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1—) 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.).
(_ 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 _ 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:
LQPER111IT
WARNING: FAILURE TO SECURE WO 2RS' C PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAE�L I AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS IS100,b001. IN ADDITION T T E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, I T REST, 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 ermit.-
2. Any permit issued as a result of this applicati beco as null and void if work is not commenced
within 180 days from date of issuance of su h permi , or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this applicat and state that the bove in rmation is correct. I agree to comply with all
cit an co t ordinances and a laws relatin to buildi onst ction, and hereby authorize representatives
Y y� Y 9oj Y P
of this unt to enter upon above-mentioned property spe tion purposes.
(Applicant or Agent):
,.Application Number . . . 06-00003910
Permit . . . . . . BLDG'POOL PERMIT ;.
Additional desc .
Permit Fee . . '317.00 Plan Check
Fee
206.05
Issue Date . . . . Valuation
35000
Expiration Date 5/06/07
Qty Unit Charge Per
Extension
BASE FEE
252.00
10.,00 6.5000 THOU BLDG 25,001-50,000
65.00
Permit . . . MECH POOL
Additional desc .
Permit Fee . . . 26.00 Plan Check
Fee
6.50
Issue Date Valuation
0
Expiration Date 5/06/07
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'. 5/06/07
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
8.25.
Issue Date . . . . Valuation
. .
0
Expiration Date _ 5/06/07
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. ALARMS/BARRIERS SHALL BE IN
LQPERDIIT
Application Number 06-00003910
----------------------------------------------------------------------------
Special Notes'and Comments
.,PLACE AT PRE -:PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT "INCLUDED
Fee summary Charged
Paid
Credited
Due
Permit Fee Total 421.00
.00
.00
421.00
Plan Check Total 232.05
.00
.00
232.05
Grand Total 653.05
:00
.00
653.05
LQPERAIIT
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of LaQ Uinta
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760)'777-7012
Building Permit Application and Tracking Sheet
Permit #
(\`0
Project Address: .7 7
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: �-rt am ��yf � � �I
Address: % % �3 �� �i2 S l,Ai? 8
,.Telephone:
Project Description:
City, ST, Zip: ?�,.iQ/r✓'> �'ZZ j
Telephone: �7 _5110
nn(60
State Lic. # :"'9- �S� S�`T City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Q
lam^�
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add -:n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: • 1��
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd .
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy .Cales.
Plans picked up
Constructon
Flood plain plan
Plans resubmitted
Mechanical
Grading,plan
2'4 Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted.
Grading
IN HOUSE: -
Review ready for corrections/issue
Developerlmpact Fee. ;
Planning Approval
Called Contact Person
A I p p
Pub. Wks. Appr
Date of permit issue.
School Fees
- .
Total Permit Fees .