06-3308 (RPL)P.O. BOX 1504 Tii!t 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 06-00003308 Owner:
Property Address: 53264 VIA PISA BARNES
APN: 772-500-055- - - 53264 VIA PISA
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 40000
Contractor:
Applicant: Architect or Engineer: WESTERN POOLS
P.O. BOX 1047
INDIO, CA 92201
(760)200-1110
Lic. No.: 348768
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/12/06
D
SEP 20 2006
CITY OF LA QUINTA
FINANCE DEPT.
--————————---——————————————————————————————————————
LICENSED CONTRACTOR'S DECLARATION
———————————————————————————————————————————————
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals 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
Licens Class: C53 License No.: 348768
�f ZO - �a��
ate: tor: %`Pc"—'
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Q issued.
IY I have and will maintain workers' compensation insurance, as required by Section 3700 of the labor
i� Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FLTND Policy Number 1270996-2006
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of th bor, Code, I shall forthwith 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
Zate:9'
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:
licant:
(_) 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE. LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 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: I ll
Lender's Address: Pi
LQPERAIIT
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 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
c�andounty ordinancesand tate laws relating to building construction, and hereby authorize representatives
ounty to enter upo a above-mentioned property for inspection purposes.
�ZP'el� nature (Applicant or Agent): ,/ga,1� '
Application Number . . . . . 06-00003308
Permit . . . BLDG POOL PERMIT
Additional desc
Permit Fee . . . . 349.50 Plan Check Fee 221.18
Issue Date . . . . Valuation . . . . 40000
Expiration Date . . 3/11/07
Qty Unit Charge Per Extension
BASE FEE 252.00
15.00 6.5000 THOU BLDG 25,001-50,000 97.50
----------------------------------------------------------------------------
Permit . . . MECH POOL
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation 0
Expiration Date 3/11/07
.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 . . 3/11/07
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 3/11/07
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
LQPERMIT
tr
Application Number . . . . 06-00003308
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary- Charged Paid Credited Due
----------------- ---------- ---- - ----- ---------- ----------
Permit Fee Total 453.50 .00 .00 453.50
Plan Check Total 253.18 .00 .00 253.18
Grand Total 706.68 .00 .00 706.68
j
LQPERMIT
3!8" SCREENED
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31$ SCREF_iVED 16/-8 760-200-1110.... Fax 760-200-4777 .
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Bin #
City of La Q uinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: S3
Z
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Owner's Name: a rKe
A. P. Number:
Address: 5S Z (P V!Q A'j
Legal Description:
Contractor: Was
e r
DO
City, ST, Zip: ),,,L V
Telephone:
Address:
I• `p
Project Description: �� S
City, ST, Zip: 6e T
V
V k
Telephone: ZO c)
State Lic. # : -3q19
768
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
r
e h L I'
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
L
Plan Sets
Plan Check submitted
Y/L 0
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2n4 Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
AJ.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees