05-3663 (RPL)1
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 05-00003663
Property Address: 80147" VIA PESSARO.
APN: 772-550-027- - -
Application description: POOL. - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL D 0
Application valuation: .40000
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Applicant: Architect or �ngi eer: u -2 0J
"" OP LA �fAimTA
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LICENSED CONTRACTOR'S DECLARATION
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 full force and effect.
Licensees class: g53 License No.: 598681
Date: V I 0 I Contractor: a �J V IX` i% Poo
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 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 1, 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 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.). a '
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
HOUSTON
80147 VIA PESSARO
LA QUINTA, CA'92253
Contractor:
AINSWORTH POOL CONSTR, ROBERT
40900 GLENMORE DRIVE
PALM DESERT, CA 92260
(760)568-4993
Lic. No.: 598681
VOICE (760) 777-7012
FAX (760) 777-7011 `
INSPECTIONS (760) 7.77-7153.
Date: '8/18/05
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.
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 VIRGINIA SURETY Policy Number 005-0024833
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 as to become -subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
00 of the Labor Co/d/��►, `11 s[�h1!@�II forthwith �comply withlrtlhose provisions.
te: L
Applicant: 1'1 a
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 (5100,000). 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
EES:-
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 ouinta, 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 ermit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state t t the ab a information is correct.- I agree to comply with all
city and county ordinances and state laws relating building onstruction, and her y authorize representatives
of thi�qunty Jo enter upon the above-mentioned p perty for inspection purpy8e5�
(Applicant or Agent):
Application Number . . . . 05-00003663
Permit: . . . . BLDG POOL PERMIT .
Additional-desc
Permit Fee . . . . 349..50 Plan Check
Fee
227.18
Issue Date Valuation
40000
Expiration Date..".. 2/14/06
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 2/.14/06
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 P1an.Check
Fee
11.25
Issue'Date. Valuation
. .
. 0
Expiration.Date .. 2/14/06
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 2/14/06
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 .
Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
LQPERMIT
4
Application Number 05-.00003663
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' -----Special Notes and Comments
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,
PLACE AT PRE -PLASTER INSPECTION.
`
{ EQUIPMENTYENCLOSURE NOT INCLUDED
Fee summary Charged,
Paid
Credited`
Due
---------- ----------
Permit Fee Total 453.50.
I
.00
---------
.00,
-453.50
Plan Check Total` •253.18'
.00
00
253.18
Grand Total .._ 706:68.•
.00
.. 00. .
`,706.68
LQPERMIT _ _ j •
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