06-4092 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
.LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING .PERMIT
Application Number: 06-00004092
Property Address: 80093 VIA PESSARO -
APN: 772-550-024- - -
Application description:-. STRUCTURES OTHER THAN BUIL ¢
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 500 MAR
K2 2 2007
Applicant: Architect or Eng eer`. cliydP0
c1�' NlA
a
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of.perjury'that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in fullforceand effect.
License Class: C53 yLiic�ensse�N�o.: 409386
Date: 312 2 O� 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 1$500).:
(_ I 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.).
(_ 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(sl licensed
pursuant to the Contractors' State License Law.).
(_ ) I am exempt under Seca , 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 peimit is issued ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
X
i
LQPERMIT
VOICE (760) 777=7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/22/07,
Owner: E
SOMERS CONSTRUCTION
80-093 VIA PESSARO
LA QUINTA, CA 92253
.Contractor:
MISSION VALLEY POOLS & SPAS
8284 MIRAMAR ROAD
SAN DIEGO' CA 92126
(858)695-2007
Lic. No.- 409386
——---------------—
WORKER'S COMPENSATION DECLARATION
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 CLARENDON NAT' L Policy Number 01KR0033006
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 asno become subject to the workers' compensation laws of California,
and agree that, if I should c me subject to the the
compensation provisions of Section
�l
3700 of the Labor Code, I II f fiWith comply with those provisions.
3
Date:. 1 u j D1 Applicant: '
WARNING: FAILURE TO SECURE WORKERS' 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 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 abo a information is correct. I agreetocomply with all
city and county ordinances and state laws relating to buildin nstruction, and hereby authorize representatives
of this county to�efnter'upon the above-mentioned property f r nsp purposes.
Date: 5 Z 2 o r Signature (Applicant or Agent):
Application Number . . . 06-0000409.2
` Permit. BUILDING PERMIT
Additional desc .
Permit -Fee 15.00
Plan Check.
Fee
9.75
Issue Date
Valuation
500
Expiration Date . . . 7/21/07
Qty Unit Charge:;. Per
Extension
..BASE FEE
15.00
----------------------------------_-----
Specia.l Notes and Comments
FIREPIT PER APPROVED PLAN.
---------------------------------------
Other'Fees . . . . ENERGY`REVIEW
FEE.
-.---------------
.98
Fee summary Charged Paid
Credited
Due
---------
Permit Fee Total 15.00
----------
.00
----------
.0,0
15.00
Plan Check Total 9.75
.00
.00
9.75
Other Fee Total .98
.00
.00
.98
Grand Total 25.73
.00
.00
25.73