05-4320 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 45-0.0.00432.0
Property Address: 80646 VIA PESSARO
APN: 772-500-011- - -
.Application description:. POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 30000
Applicant'
Architect or Engineer:'
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CAMPBELL
80-646 VIA PESSARO
O LA QUINTA, CA 92253
v QFC � 6
ci ?Ops
-1 LICENSED CONTRACTOR'S DECLARATION.-
- I hereby affirm underpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and o ionals Code, and my License is in full force and effect. `
License C ss• Licen No.: - - -
ate: L Contra r.
j - OWNER -BUILDER DECLARATION -
I hereby affirm under penalty of perjury than am exempt from the Contractor's State License Law for the -
i 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 theapplicant 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 Professibns 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 'l, 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.). -
,'as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
Ar - 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
IORTH POOL CONSTR, ROBERT
VIRGINIA SURETY
Q��Ij�/WC 005-0024833 01/01/06
C LB: 598681 07/31/06
------ --------------
---------------
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. '
14 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 C53 Policy Number ---=------ ----
I certify that, in the performance of thework 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 f should beco 'ect to the workers' compensation provisions of Section -
3700 of the Labor Code, I s forthwi comply with those provisions. _
D : 7- (0 SApplica
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.
certify that I have read this application and state that the above informationis correct. I agree to comply with.all
city and county ordinances and state laws relating to building construction, and hereb authorize representatives ...
of this cou to enter upon the above-mentioned prope p i purposes.
Date: t Signature (Applicant or Agentl: -
VOICE (760) 777-7012
FAX (760) 777-7011 .
INSPECTIONS (760) 777-7153 .
Date: 9/26/05
Application Number 05-00004320
r
Permit BLDG POOL'PERMIT
Additional desc_
Permit Fee . . . . 284.50 Plan Check
Fee
184.93
Issue Date . . . . Valuation
30000
Expiration Date 3/25/06
r
Qty Unit Charge Per
Extension
BASE FEE
252.00
5.00 6.5000 THOU BLDG 25,001-50,000
32.50
Permit . . . MECH POOL
Additional desc .
Permit Fee . . 26.00 Plan Check
Fee'.
6.50
Issue Date. Valuation
0 4
Expiration Date . 3/25/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
w
1.00 '' 11.0000 EA- MECH FURNACE >100K
11.00
Permit ': POOL PERMIT. -RES
�J
„ELEC
Additional desc '.
Permit Fee 45.00 Plan Check
Fee
11.25
Issue Date.. Valuation'
0
-
Expiration Date 3/25'/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 3/25/06
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 ONLY. ALARMS/BARRIERS SHALL
' . LQPERMIT -
• _
Application Number 05-00004320
- -------------------------------------------------------
Special Notes and Comments
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid
Credited
Due
}'
----------------- ---------- ---------- •--------=-
Permit. Fee Total 388.50 .00
----------
.00
388.50
Plan Check Total 210.93 .00
.00
210.93
Grand Total 599.43 .00
.00
599.43
}
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