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07-1125 (RPL),-.P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4 -ht 4.4 Q" Applicant: Architect or Engineer: ate' 0A ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury t licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bus' ess amn Prof 'onals Code, and my License is in full force and effect. Licen6C ss: CS3 License No./ 598681 Date: Contractor: OER-B DER DECLARATION I hereby affirm under penalty of perjury a am empt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business a d Pro ssions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or re it an 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 _ I 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 contractors) licensed pursuant to the Contractors' State License Law.). 1 _ I 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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/18/07 Owner: CASEY RESIDENCE 78-241 DEACON DR. W. LA QUINTA, CA 92253 Contractor: AINSWORTH PO ONSJ?Q R l 07 40900 GLENMO RIV " 1 PALM DESERT, CA C1 0�r QUINTA i c. Zoo - 2 s o FINANCE bEPT Lic . No.: 598 ----------------------------------------------— 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 CALIF INS Policy Number 460030110102 _ 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 ou beco bject t the workers' compensation provisions of Section 1 3—f700 of the Labo Code sha f /r1 wit omply with those provisions. Date I fl 1 Applicant: I/ WARNING: FAILURE TO SECURE O ER OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRI IN PE LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDI 0 0 COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR C E, IN REST, 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 th ve information is correct. I agr to comply with all city and county ordinances and state laws relating to bu ding onstr ucti and hereby out ize representatives of this court (y tt9I,••enter upon the above-mentioned grope y for ns c" n p r oses. Date: iy �I Y�, Signature (Applicant or Agentl:' 'Application Number:-- —07-00001125 -- - Property Address: 78241 DEACON DR W APN: 770 -280 -.022 - Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 40000 T4 -ht 4.4 Q" Applicant: Architect or Engineer: ate' 0A ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury t licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bus' ess amn Prof 'onals Code, and my License is in full force and effect. Licen6C ss: CS3 License No./ 598681 Date: Contractor: OER-B DER DECLARATION I hereby affirm under penalty of perjury a am empt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business a d Pro ssions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or re it an 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 _ I 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 contractors) licensed pursuant to the Contractors' State License Law.). 1 _ I 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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/18/07 Owner: CASEY RESIDENCE 78-241 DEACON DR. W. LA QUINTA, CA 92253 Contractor: AINSWORTH PO ONSJ?Q R l 07 40900 GLENMO RIV " 1 PALM DESERT, CA C1 0�r QUINTA i c. Zoo - 2 s o FINANCE bEPT Lic . No.: 598 ----------------------------------------------— 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 CALIF INS Policy Number 460030110102 _ 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 ou beco bject t the workers' compensation provisions of Section 1 3—f700 of the Labo Code sha f /r1 wit omply with those provisions. Date I fl 1 Applicant: I/ WARNING: FAILURE TO SECURE O ER OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRI IN PE LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDI 0 0 COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR C E, IN REST, 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 th ve information is correct. I agr to comply with all city and county ordinances and state laws relating to bu ding onstr ucti and hereby out ize representatives of this court (y tt9I,••enter upon the above-mentioned grope y for ns c" n p r oses. Date: iy �I Y�, Signature (Applicant or Agentl:' �w. Application Number .. . . . . 07-00001125 Permit BLDG POOL PERMIT Additional desc Permit Fee 349.50 Plan Check Fee 227.18 Issue Date . . . . Valuation 40000 Expiration. Date 10/15/07 Qty Unit Charge Per Extension BASE FEE 252.00 15.00 6.5000 THOU BLDG 25,001-50,000 97.50 ---------------------------------------------------------------------------- Permit . . . MECH POOL Additional desc . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . 0 Expiration Date 10/15/07 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 10/15/07 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. 39.00 Plan Check Fee 9.75 Issue Date . . . . Valuation . . . . 0 Expiration Date 10/15/07 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 6.0000 EA PLB FIXTURE 18.00 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 Ai� LQPERMIT Application Number . . . . . 07-00001125 Special Notes and Comments PLACE AT PRE -PLASTER INPECTION. FOUNTAIN PER APPROVED PLAN. EQUIPMENT ENCLOSURE NOT INCLUDED. Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 459.50 .00 .00 459.50 Plan Check Total 254.68 .00 .00 254.68 Grand Total 714.18 .00 .00 .714.18 bin # Gity of La Quinta Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit .# vJ Project Address: C{ Q Jx (I tv Owner's Name: C �( A: P. Number: Address: 7 Legal Description: Contractor: ni5(QGC774N City, ST, Zip: Telephone: Address:- Project Description: �(N� m, -,,-vv GPOOL' Ifq City, ST, Zip: t Q'tM AIN IV OInM/rj N /V Lf Telephone: City Lic. #: N G State Lie. # : Arch., Engr., Designer: i Address: City, ST, Zip: Telephone: State Lie. #: Construction Type: Occupancy: Project type (circle one): New Add'n . Alter Repair Demo. Name of Contact Person: - dO l Sq. FL: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Proj : L4 6 APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal . Req'd Recd TRACMG PERMIT FEES Plan Sets Plan Check submitted % W Item Amount Structural Cales. i Reviewed, ready for corrections Plan. Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Floodplain plan Plans resubmitted Mechanical Grading.plart 2".1keview, ready for corrections/issue Electrical $ubcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees i 1 s • •� ■ ■ •�•r.1• ■ fir, • Iy�*1��1 �••�� V.J ��� � •■Ta r1, l� r � � �,.i.�■ - � O o � /.�. Vit; "" `� i u � s Mu swim ��•-� � ___ � -- - - `'� AMM . �•i:•'. (__,:..�. �„ ......U�r.-- ►'��•� ••�•rrr •err..■r'� - � 11,1010•i . lq ...-..- , • i a • NO. • • EL APPROVED PAD: 11 . , • UNIN ••'i.