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05-2756 (RPL)4 P.O. BOX 1504 78-495 CALLE TAMPICO p LA QUINTA, CALIFORNIA 9225 D DING &SAFETY DEPARTMENT JUL 15 2005 BUILDING PERMIT Application Number: X05=00002756' Owner: Property Address: 81309 GOLDS( FLAQCiIi MABBOTT APN: 764-270-999 87 - WARISSEDEPT. 81-309 GOLDEN BARREL WAY Application description: • POOL - RESI A LA QUINTA, CA 92253 Property Zoning: MEDIUM HIGH DENSITY RES Application valuation: 20000 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Contractor: Applicant: Architect or Engineer: FAMILY POOL CONSTRUCTION WCC: STATE FUND WC: 1344032-2005 03/01/06 aN r/CA-UTOI� P JA CSLB: 658996 11/30/06 Date: 7/05/05 - - - - - - - - - - - - - - - - - - - i - - r - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — LICE ED NTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I a l��duaLprovisions of Chapter 9 (commencing with Section 7 00) o Division 3 of the Business an ode, and my License is in full force and effect. Licensely ss:, � nse No.: pate: / Contractor: O1 R -BUIL ER DECLARATION I hereby ffirm u der penalty of perjury that I am ex pt 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 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 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: 1.0 Lender's Address: LQPER11iIT 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. Jt 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 C53-HIC Policy Number - - - - - - - - - - - - - -- _ I certify that, in [he pe o�ome �eo r which this permit is issued, I shall not employ any person in any mann ct to the workers' compensation laws of California, Ind agree that the workers' compensation provisions of Section A 3 of t mply with those provisions. WARNINF: FAILURE TO SECURE WOR RS' COM>s6NSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO HE 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 applicatKormation and void if work is not commenced within 180 days from date of issuance of stion of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that thion is correct. I agree to comply with all city an un ordi nces and state laws relating to b ', and hereby authorize representatives of' co o er upon the above-mentioned erurposes. Date Signature (Applicant or Agent): Application Number . . . . . 05-00002756 Permit . . . BLDG POOL PERMIT Additional desc . . Permit Fee . . . . 207.00 Plan Check Fee 134.55 Issue Date Valuation 20000 Expiration Date 1/01/06 Qty Unit Charge Per Extension BASE FEE 45.00 18.00 9.0000 THOU BLDG 2,001-25,000 162.00 ---------------------------------------------------------------------------- Permit . . . MECH POOL Additional desc . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/01/06 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 . . 1/01/06 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 7.50 Issue Date . . . . Valuation . . . . 0 Expiration.Date 1/01/06 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 . . . . . 05-00002756 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 311.00 .00 .00 311.00 Plan Check Total 159.80 .00 .00 159.80 Grand Total 470.80 .00 .00 470.80 C LQPERMIT +-611 6' (dock WWI p/I r _ 1 6' Black Wall a/I i a' Mm A/ C w/ rod a+► u V L�cJ MA1313M NOME { 81309 XL12n N [3AW-,fl l WAY f?