06-2633 (SOTB)P.O. BOX, 1504
78-495 CALLE TAMPICO
LA`QUINTA, CALIFORNIA 92253
Application Number: 06-00002633
Property Address: 48665 FULL MOON WY
APN: 658-140-999-130 -29436 -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 600
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MARK WILLIAMS
48-665 FULL MOON WA
LA QUINTA, CA 92253
Contractor:
MCRAE POOL & SPAS
79105 DESERT STREAM
LA QUINTA, CA 92253
(760)772-2440
LiC. No.: 823017
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
JUL 12 2006
Date: 7/11/06
µ(A
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full forc I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C53-1227 License for y of the Labor Code, for the performance of the work for which this permit is
issued.
Date: ah Contractor: _ 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
- 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).:
(_) 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.).
(_) 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
1 1 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
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
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 a rthwith co
Date: --! f -/-r-'--= Applicant;
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 this'c7ounIN t enter upon the above-mentione ty for inspection purposes.
Date: C Signature (Applicant or`t
Application Number . . . . . 06-00002633
4 Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 17.00
Plan Check
Fee
11.05
Issue Date . . . .
Valuation
. . .
.
600
Expiration Date.. 1/07/07
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 2.0000 HND BLDG
501-2,000
2.00
----------------------------------------------------------------------------
Special Notes and Comments
FIREPIT ONLY PER APPROVED PLAN .
Fee summary Charged
-------------------------------------
Paid Credited
----------
----------
Due
Permit Fee Total 17.00-
.00
.00
17.00
Plan Check Total 11.05
.00
.00
11.05
Grand Total 28.05
.00
.00
28.05
LQPERMIT
Bin #City of La Quintd
Building at Safety D'Ivision
Petah IF P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
1� Project Address g• Owner's Name- MAp
A.P. Numbs Address:
Legal Description: City, ST. Zip: jJM C4 92.2S'-'
X Contractor. S FTelephone: � �! �x z"Mv-
J� :Address Xproject Description:
�C City. ST, Zip: 3
X Td hone:
State Lic: # : City Lie. #: .
Arch.. Engr., Designer:
.Address:
City, ST, Zip:
. . I.
Total Pcrrbt( Fees
■
Telephone:
=' Construction Type: Occupancy:
ptojocc type (circle one): New Add'n Alta Repair Demo
State Lic
X
Name of Contact Person:' m C,�,q E Sg. FL:
# Stories:
# Units:
X
Telephone # of Contact Person: % Value of Project:.
APPLICANT: DO NOT WRITE BELOW THIS UNE
ti
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Cheek submitted
Item Ataouat
Structural Cita.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans jacked up
Construction.
flood plain plan'
Plans resubmitted
Mechanical
Grading plan
2' Review, ready for eorrections!issae
Electrical
Subcontactor Ust
Called Contact Person.
Plumbing
Grant Deed -
Plans picked up
S.M.L.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:.
''' Review. ready for correcdoushissue
Developer Impact Fee
Planning Approval
Called Contact Person*
Pub. Wks. App
Date of permit Issue'
Total Pcrrbt( Fees
■
_ CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS=�V� .IT1Q(')I�(_D2 _. PERMIT NUMBER OWNER. BUILDER/1)C2AE__
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their -employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement 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.
M
KA'!
V
s c
Trade / Cla s�fi anon
Contractor
:::;:::>:;::::;:::,:<:;;::
.::...:. St s License .
;; ensationarsur:..
W..orkers.Com ance: :' ` :; ;<::....:
City Busriess License':.
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xkxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
'Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
A
S
-14170-
L.23
CONCRETE (C-8). `_
.0
,J
FRAMING :(C-5) ;
STRUCT. STEEL (C-51)
%� S !
1&-07
#1 '77
` �-
6-717
MASONRY W-29)
PLUMBING (C -36)'Q,\
S
/
LATH: PLASTER (C-35)
(� �' -
�j 7
— 3
DRYWALL (C-9) .:..:
HVAC
ELECTRICAL. (C-10)'
61�t[
0222-002-44
? ?
�l `01
J
-3)
ROOFING`(0=39).:.'>'.:
$HEFT METAL (643)
FLOORINGrlC`.=:15);
GLAZING (C-17)`.'
INSULATION: (C-2)
SEWAGE DIS P; (G-42)
PAINTING (C-'33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING M-27) ' t
I
. -
POOL IC -53)
, t
?
S
��
7 0 3
License Detail
Page 1 of 2
P
License Detail J CALIFORNIA CONTRACTORS STATE LICEN
Contractor License #809896
DISCLAIMER
A license status check provides information taken from the CSLB license data base. Before
on this information, you should be aware of the following limitations:
. CSLB complaint disclosure is restricted by law (B&P 7124.6). If this entity is subject tc
complaint disclosure, a link for complaint disclosure will appear below. Click on the lin
button to obtain complaint and/or legal action information.
Per B&P 7071.17, only construction. related civil judgments reported to the CSLB are
disclosed.
. Arbitrations are not listed unless the contractor fails to comply,with the terms of the
arbitration.
. Due to workload, there may be relevant information that has not yet been entered ont
Board's license data base:
Extract Date: 07/11/2006
* * * Business Information
E NAVARRO EXCAVATION A PARTNERSHIP
P O BOX 10290
N D I O, CA 92202
Business Phone Number: (760) 275-6956
Entity: Partnership
Issue Date: 06/26/2002 Expire Date: 06/30/2008
* * * License Status * * *
This license is current and active. All information below should be reviewed.
* * * Classifications
Class . Description
0 GENERAL ENGINEERING CONTRACTOR
Bonding Information
CONTRACTOR'S BOND: This license filed Contractor's Bond number 9055619 in the arr
$10,000 with the bonding company,
http://www2.cslb.ca.gov/CSLB—LIBRARY/License+Detail. asp 7/11/2006
License Detail
AMERICAN CONTRACTORS INDEMNITY COMPANY,
Effective Date: 01/01/2004
Contractor's Bonding History
Page 2 of 2
BOND OF QUALIFYING INDIVIDUAL(1): A qualifying partner is not required to post a b
qualifying individual.
* * * Workers Compensation Information'*
This license has workers compensation insurance with the
STATE COMPENSATION INSURANCE FUND
Policy Number: 046-0015745. Effective Date: 10/01/2005 Expire Date: 10/01/2006
Workers Compensation History.
Personnel listed on this license (current or disassociated) are listed on other licei
Personnel List Other Licenses
License Number Request Contractor Name Request Personnel Name Request
Salesperson Request Salesperson Name Request
0,2006 State of California. Conditions of Use Privacy Policy
http://www2.cslb.ca.gov/CSLB_LIBRARY/License+Detail.asp 7/11/2006