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06-1783 (SOTB)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: j1 Applicant: 06-00001783 78681 DEACON DR.E 770-230-008- - - STRUCTURES OTHER THAN BUILDINGS LOW DENSITY RESIDENTIAL 17000 Architect or Engineer 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT - -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I licensed under provisions of Chapter 9 (commencing with Section 7 01 of Division 3 of the Business Professionals Code, and my License is in full force and effect. r. License a`ss: C53 /' % f , /ase No.: 518742 �f 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 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 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 . co 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.). (_) 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 1 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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/04/06 Owner: GALLAGHER DENNIS M Contractor: AMERICAN POOL CONSTRUCTION INC P.O. BOX 11996 PALM DESERT, r8 92255 (760)340-2588 LiC. No.: 518742 ----------------------------------------------- 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 STATE FUND Policy Number 0001188-2005 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 1 should beco subject to the workers' compensation provisions of Section 3700 of the Labor Code, I sh I �rthwith ccq//m�plywith those provisions. Da " JJ f Applic]a :: F � �i/�/t"l WAR NG: `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 above information is correct. I agree to comply with all city and cou ty finances and state laws relating to building con ction, and hereby authorize representatives of this cou y t enter upon the above-mentioned prope ection pub �. t Date � ignature (Applicant or Agen ., t Application Number . . . . 06-00001783 LQPERMIT Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 180.00 Plan Check Fee 117.00 Issue Date Valuation . . . . 17000 Expiration Date 10/31/06 Qty Unit Charge Per Extension r�M BASE FEE 45.00 15.00 9.0000 ---------------------------------------- THOU BLDG 2,001-25,000 =----------------------------------- 135.00 Permit . . . ELEC-MISCELLANEOUS Additional desc . . Permit Fee . . . . 17.25 Plan Check Fee 4.31 Issue Date . . . . Valuation . . . . 0 r Expiration Date 10/31/06 _ Qty Unit Charge Per Extension 1 BASE FEE 15.00 3.00 .7500 ------------------------------------------------ PER ELEC DEVICE/FIXTURE 1ST 20 --------------------------- 2.25 Permit . . . PLUMBING . Additional desc- esc Permit Permit Fee . . . . 21.00 Plan Check Fee 5.25 Issue•Date . . . . Valuation . . . . 0 Expiration Date 10/31/06 Qty . Unit Charge Per Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 r4-------------------------------------------------------- 7------------------- . Special Notes.and Comments TWO PONDS ONLY. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 11.70 i Fee summary Charged Paid Credited Due Permit Fee Total 218.25 .00 .00 218.25 q.. Plan Check Total 126.56 .00 .00 126.56 Other Fee Total 11.70 .00 .00 11.70 Grand Total 356.51 .00 .00 356.51 LQPERMIT 05/03/2006 14:04 7606749438 AMERICAN POOL CONST PAGE 01/02 Bin # City of La Qui•nta - Buiiding U Safety Division Permit # P.O. Box. l SO4, 78-495 Calle Tampico '&3 W Quinta, CA 9225'3 -.(760) 777-.7012 Building Permit Application and Tracking Sheet Project Address:'( C Owner's Name: J tz'yi (l A. P. Number: Address: regal Description: City, ST Zip: I n �_ C•�, Contraptor: C Telephone: Address:7- d' i Project Descriptio :2 City, ST. Zip: Telcphorlo: 3Z Stan Lic. # :� City. Arch., tang., Designer: Address: City, ST, Zip: Telephone: Com&uction Type: 0=pancy: State Lic.#: Projcd type (citcte one): New :4dd'n Alta Repair Demo Name of Contact Person: Sq. Ft: # S' torics- # Units: Tel hone # 4f Contact Person: ' ,- Estimated Value of Project: APPUGANT: DO NOT WiUTE•BELOW THIS UNE # Submittal _ Rcq•d Reed TRACIMG . MpJaT FEES Plan Sets . Pias Cheek submitted• IV13 p Item Amount Stryetural Cates. Reviewed, ready for corrections Pk.0 Check Deposit ' S© F I Truss Cates. Called Contact Person Pian Check Balance Energy Pales. Piaw.oicked up. Construction Flood plain plan pians resubmitted Mechanical Crading.plaa 2"' Raview, raady fer.correetlousftsut trlectrical FtY Subcontactor Ltst Called Contact Person Plumbing a**N i Grant Dred kilns picked up S.M.L' MO.& Approval Plans resubmitted Grading IN HOUSE:- '" Review, ready for con'eetionstissue Acvoloper Impact Pee Planning Approval Called Contact Person A,I.P.P. Pub, Wks. Appr Date otpermit Issue Sthool Fees Total Pcrmit pees M 9b I ulr=7 re ZT/' op 3'N