05-4789 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
0( 5-00004789 7
78691 DEACON DRE
770-230-009- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
30000
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I a ed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business a Profes 'ovals Code, and my License is in full force and effect.
License Cllass: License
KAAoy J..
✓Date: �iJ Contract
III NER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason ISec. 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, 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 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 L ).
(_ 1 I am exempt under Sec. , B.&P.C. f thi 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
Owner:
CLARK CLIVE A
Contractor:
AINSWORT
WCC:
WC:
CSLB:
H POOL CONSTR, ROBERT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/26/05
VIRGINIA SURETY
005-0024833 .01/01/06
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.
Q I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
r�- 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 th ork fo hich this permit is issued, I shall not employ any
person in any manner so as to be me subject t the workers' compensation laws of California,
and agree that, if I sh co subject to the ork�thffvisions.
'ensation provisions of Section
eg�3700 of the Labor/o , I sha orthwitl comp) with
Applicardr rif 340
WARNING: FAILURE TO SECURE WORKERS' CNMEIISATION 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, orcessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above infor tion is rect. I agree t comply with all
city and county ordinances and state laws relating to building constru ion, and he by authori sentatives
of this co my to enter upon the above-mentioned prope a ion p rpos
DAignature (Applicant or Agent):
Application Number . . . . . 05-00004789
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
284.50 Plan Check Fee
.184.93
Issue Date . . . .
Valuation . . .
. 30000
Expiration Date
4/24/06
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
Expiration Date
4/24/06
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 Plan Check Fee
11.25
Issue Date . . . .
Valuation
0
Expiration Date ..
4/24/06
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..
4/24/06
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 . . . . . 05-00004789
---_----------------------=-----------------------------------
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
LQPERMIT
».`I1a
Sent By: AINSWORTH POOLS;
01/Z6/�00a 16:10 7607777011
ft" 1 City of La Quints
/uldft C safety DkMon
P.O.: In 1 SO4, 74-49S Care Tan*jw
U Q*wA U 92-253.- (760) 777-7012
Building: PervOit Application and'Tracking Sheet
L aN Q (i, Cha�acr'r Nan►r_ . •. NQ(14 �J'. - .1".9.
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L'A Q UINTA
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