05-3302 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA .92253
Application Number: <];Q05�;0:0:00-33-:02
Property Address: 78464 VIA PAVION
` APN: 604 -032 -009 -24 -305211 -
Application description: POOL - RESIDENTIAli
Property Zoning: LOW DENSITY RESIDENTIAL
Application. valuation: 26000
Applicant: Architect or Engineer:
e
y.4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
----------------------------------------------------
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 id Profess'6nats. ode, and my License is in full force and effect.
License Class: ense
ate:O'� b v Contract
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).:
(_ 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 offeredfor 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.). -
(_ 1. 1 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.)s
' Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Date: 8/01/05_
Owner:
HOY, JOHN
78-464 VIA PAVION D
LA QUINTA, CA
LA QUINTA, CA 92253
AUG o
Contractor:
A & R COMPLETE POOL SERVI E CITYVO L-A QUIjyM
WCC: EXEMPT
-6EPr
WC: EXEMPT 09/30/05
CSLB: - 841981 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. '
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 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 a should ecome subje t tot workers' compensation provisions of Section
�(� 153700 of the La r Code s I forthw' co Iy wit ,hose provisions.
a®-te: 0
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAG 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 th it the above' -information is correct. I agree to comply with all
-.city and cou ty'ordinances and state laws relating bui ding c struction, and h by a ize representatives
of this . my to enter upon the above-mentioned ro rty fo spectio urp es.
Dat 0 S Signature (Applicant or Age
Application Number
05-00003302 �.
: Permit
BLDG -POOL -PERMIT
Additional desc
-
Permit Fee' <•.
258 .'50 Plan �Check Fee
168.03
Issue,Date
Valuation . .
26000
„ Expiration Date
1/28/06
_.-:- Qty Unit Charge
'
Per
Extension
BASE"FEE.
252.00 _
" 1`.00' 6.5000
-------------------------------------------------------------------------------
THOU BLDG 25,001-50,000
6.50
Permit
MECH POOL
Additional desc ,
Permit Fee ..
26.00 Plan.Check Fee
,6.50
Issue Date
Valuation
0
Expiration Date
1/28/06
Qty Unit"Charge
Per
Extension
BASE FEE
15.00
1.00 .11.0000
------------------------------------------------------------------------
EA MECH FURNACE >100K
11.0.0
Permit
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee.
45.00 Plari Check Fee
11.25
Issue Date . . . .
Valuation
0
Expiration Date ..
1/28/06
Qty Unit Charge
Per
Extension
x1.00
BASE FEE
15.00
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 .
1/28/06
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 l-4 OUTLETS
3.00
Special Notes and Comments
POOL& SPA ONLY. ALARMS/BARRIERS
SHALL
LQPERAIIT - -
.
-
-clip
:-i
lv v V-1 _^
J
L 1
.
'
A
i
��
i
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
t
APPROVED
FOR CONSTRUCTION
(
u
12: 46p..
(I��?_ /AY1-0IJ
CITY OF LA QUINTA SUB=CONTRACzOR
LIST
JOB ADDRESS,
PERMIT NUMBER 0 X302 01NNEF _.._ _�,� t �i �S ��`
BUILDER 'I-t X 11 in
a
This shall a
-' it t B
11 ti s • . o s icuous
lac . Only persons. a
pearing on this list or their
employees are authorized to- work
on this job.' Any changes
to this must be approved by the Building Division prior. to ommencement of -work. .Failure to
comply will result in a
stoppage of work and/or the voidance
of building.permit. For each: applicable trade, all .information requested below must be completed by
applicant. ."On File".is not an. acceptable response.
;e
..:.:Stat�......t►tt'_cCor...<sa,�een�
:.:.<.:.....:
' Company Name
Y
Classification
License a
e e Nu :. Ex . D t e
Number
er P
Ca r' Name
r ger
P i Number'
Policy m
Y
Ex .Date
P
e u
Number
License N m
z D
E ate
P•
(e.g. A, 8, C-8) .
(xxxxxx) (xx/xx/xx)
(e.g: State Fund, CalComp)
(Format Varies)
(xxlxxlxx)
fxxxx)
(xx/xxlxx)
>iTkViIQRK (,G X 2I
l
ASS ►1 �l r.� -
`
rj. C
2AE F1ri�
1-11.99 �:-`ti
1D t`t b
il3
J�
'FF3iA1�'! ` zt
fir,,.;; A.
c
%
�(. o�
ST f. .�
4. tlu!tLj
(1!'S
`)G'il.
l.�-c ,'cK;
,.
.
6 Pk1
4- 3
X11: 1 0
• s
�-
j
.,1. .. :• ri
r�7 I -S
01-53
i
J r I s
1
.� ti.( n' t� rl
t�J ��
'�• 1 I�
,� -753
SO
i
.; >>
r
Mst��;angN:
-
p;
CRAiti11TiEEIC':=5!35 <_'`>`
,_
....c.....t
.
........:..::. .
-
G5
C �.
r v
3
..
i