06-1672 (SOTB)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 06-00001672 Owner:
Property Address: 81835 GOLDEN STAR WY MC DOWELL
APN: 764-280-999-83 -300235- 81-835 GOLDEN STAR WAY
Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA, CA 92253
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 1500
Contractor:
Applicant: Architect or Engineer: CALIFORNIA POOLS & SPAS
(� P.O. BOX 1280
®®!P C0ACHELLP CA 760)398-9222 922.36
6 Lic. No.: 656128
LICENSED CONTRACTOR'S DECLARATION
I 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 krofessionals Code, and my License is in full force and effect.
License
Cllaasps: CB C27 C29 license No.: 656128
Contr. or:
OW ER -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).:
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 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.).
( 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
>A P
t
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
------------------
WORKER'S COMPENSATION DECLARATION
Date: 4/28/06
1 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 SEABRIGHT Policy Number 13B1060510
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 ecome subject to the workers' compensation provisions of Sectton
[/ 3700 of the Labor Cod L II forthwith comply with those provisions.
[Tate' ` —2 �{'(ApplicaaYor
WARNING: FAILURE TO SECURE WORKE S' 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 build' 9'��struction, and hereby authorize representatives
of this county to enter upon the above-mentioned prop for p� tion purposes.
Dafe:—Z �`�gSignature (Applicant or Agent):
Application Number . . . . 06-00001672
Permit . .
. BUILDING PERMIT
Additional desc .
Permit Fee
35.00
Plan Check
Fee
22.75
Issue Date
Valuation
. . .
. 1500
Expiration Date
10/25/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
10.00 2.0000
HND BLDG
501-2,000
20.00
----------------------------------------------------------------------------
Special Notes and
Comments
FIREPIT (AGAL 496)
ONLY.
-----------------------------------------------------------
Other Fees . . .
. . . . . . ENERGY REVIEW FEE
-----------------
2.28
Fee summary
Charged
--------------------
raid Credited
----------
----------
Due
-----------------
Permit Fee Total
35.00
.00
.00
35.00
Plan Check Total
22.75
.00
.00
22.75
Other Fee Total
2.28
.00
.00
2.28
Grand Total
•60.03
.00
00
60.03
LQPERMIT
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, City of La Quinta��
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'permit # Tampico
La'�:Q.uinta, CA: 92253.-.(760:) 777=:70.12
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GAS SHUTOFF
VALVE GRAVEL
LOCATED GAS LOG
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(TYP. ),
0
F.S. -
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METAL GAS RISER
2" DRAIN OR PROVIDE 12" DIAMj
OPENING IN FOOTING
GAS LINES SHALL BE INSTALLED
PER CPC FOR DEPTH,
COURSE - _WATER PROOF t,OvtRAGE; AND PLACEMENT.
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