07-1139 (RPL)1r
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-00001139
Property Address:
78231 DEACON DR W
APN:
770-280-023- - -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
30000
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
1 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.
License Class: C53 L',No.: 348768
ate: Zo ontractor:
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 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, 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—) I am exempt under Sec. , BAP.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: Ole
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/17/07
Owner:
JUSTIN WILSON
78231 DEACON DRIVE WEST
LA QUINTA, CA 92253
Contractor:
WESTERN POOLS
P.O. BOX 1047 jl'D
INDIO, CA 92201 f 4 /y
(760)200-1110 U
Lic. No.: 348768
C1 A�� e `� 200
?OPI .
---------------- --- - - - - -- •',�i-'4--
WORKER'S COMPENSATION Dla�ly'.
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' com ti n, 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 1270996-2007
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
3700 of the Labor Code; I shall forthwith with those provisions.
nt: I
plica
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.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of/th/iy4ounty to enter upon the above-mentioned prope�fo tio
/ n pu�po e
aD te: L{ t Si ature (Applicant or Agent): (/r
Application Number . . . . . 07-00001139
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee
284.50 Plan Check
Fee
184.93
Issue Date . . . .
Valuation
30000
Expiration Date
10/14/07
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
10/14/07
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
10/14/07
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
10/14/07
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
l;.
Application Number 07-00001139
----------------------------------------------------------------------------
.Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
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
Bi" #
City of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit .# Q�
Project Address:' 70 1 be ga k V r p W
Owner's Name:.fi\\t
A. P. Number:
Address: U
Z a i eA -e-Oh r- o f
Legal Description:
Contractor: e e(K �OD
City, ST, Zip: Lx_ Qvii,,cfa CA
Telephone:
Address: 1 j
--411 1
11
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WESTERM POOLS,
78409 Darby Rd.
Bermuda Dunes, CA. 92203
Ph. 760-2 00-1110 Lic. 348768
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