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09-0005 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000005 Property Address: 53569 VIA PISA APN: 772-530-046- - - Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 20000 Applicant: cot Ti-tyl 4 4 Q" Architect or Engineer: pa BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICEN ED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjur hat I am ense er provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busine Pro od nd my License is in full force and effect. License ass- C8 C27 C29 is a o.: 656128 C tractor: OWN - DECLARATION I hereby affirm under penalty of perjury that I am ctor's State License Law for the following reason (Sec. 7031 .5, Business and Prof sions Code: Any city or coup t 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 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 proving that he or she did not build or improve for the purpose of sale.). (_ I 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 Owner: PETER JACOBS PO BOX 356 LA QUINTA, CA 92253 Contractor: TESERRA P.O. BOX 1280 COACHELLA, CA 92236 (760)398-9222 Lic. No.: 656128 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/07/09 D1 L AN 0 72009 i CITY CP .t,4 1 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 SEABRIGHT Policy Number BB1080510 I certify that, in the p rformanc of the work for which this permit is issued, I shall not employ any person in any man r so as to��lectl to the workers' compensation laws of California, an?dd algree that, if I s Id beco heworkers' compensation provisions of Section 37Q9 of the Labor Code,aPly with those Provisions. Da�plicant: _ WARNING: F-1 IRETO SECURE SUBJECT AN EMPLOYER TO CRIP DOLLARS ($100,000). IN ADDITI SECTION 3706 OF THE LABOR O KE ' RAGE IS UNLAWFUL, AND SHALL . P NALTIES AND P TO ONE HUNDRED THOUSAND THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN 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 and void if work is not commenced within 180 days from date of issuance of mit, oipu sation o rk for 180 days will subject permit to cancellation. I certify that I have read this application and state that t above in ori rr . I agree to comply with all city and county ordinances and state laws relating to buildi onstr c d e horize representatives of this co -unto to eater UppUhe,above- s (Applicant or Agent): Application Number . . . . . 09-00000005 Permit . . . BLDG POOL PERMIT Additional desc . . Permit Fee . . . 207.00 Plan Check Fee 134.55 Issue Date . . . . Valuation . . . . 20000 Expiration Date 7/06/09 Qty Unit Charge Per Extension BASE FEE 45.00 1.8.00 9.0000 THOU BLDG 2,001-25,000 162.00 Permit . . . MECH POOL Additional desc . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . Valuation . . . . 0 Expiration Date . . 7/06/09 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 . . 7/06/09 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 . . 7/06/09 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 LQPERMIT Application Number . . . . . 09-00000005 ---------------------------------------------------------------------------- Special Notes and Comments PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due - ----------------- Permit Fee Total -------------------- 311.00 .00 -------------------- .00 311.00 Plan Check Total 160.55 .00 .00 160.55 Other Fee Total 1.00 .00 .00 1.00 Grand Total 472.55 .00 .00 4.72.55 LQPERMIT