HomeMy WebLinkAbout07-2939 (RPL)P.O.AOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00002939
Property Address: 78850 LIMA
APN:' 772-102-015- - -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: • 30000
Applicant:
�v
Architect or Engineer:
1 A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7 00) f Division 3 of the Business andArofessionals Code, and my License is in full force and effect.
License
1C s$: C53 Ifinse No.: 518742
rDate:, ` Contra or: t
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of pe ry 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 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, 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 _ 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:
i
LQPERMIT
Owner:
SCHLEY RESIDENCE
31112 VIA PARED
THOUSAND PALMS, CA 92276
Contractor:/AA
AMER I CAI
P.O. BOXJ 996
PALM DES C�!C9��E2 200
(760) 340, 588 IdacJ J
LiC. No.k 5L%-42--
CITY OF LA QUINTA
FINANCE DEPT
VOICE (760) 777-7012
FAX {760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/14/07
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 CNCLD/ST FUND Policy Number 0001188-2007
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
pe son in any manner so as to become subject to the workers' compensation laws of California,
a d agree that, if I should become subject to the workers' compensation provisions of Section
tJ 00 of the Labor II forthwith comply with those provisions.
Date: /l ` Applic t:
7
WARNING: AILURE TO SE RE KERS' 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 n truction, and hereby authorize representatives
of this co my enter upon the above-mentioned pro f i ectiora,perylOSE .
Date `�gnature (Applicant or Agent):
I' P
Application Number .
. . . . 07-00002939
• Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
284.50 Plan Check Fee
184.93
Issue Date . . .
Valuation . . .
. 30000.
Expiration Date
5/12/08
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
5/12/08
Qty Unit Charge
Per
Extension
I
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
5/12/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
------------------------------
EA ELEC PRIVATE SWIMMING POOL
--------------------------------------------
3.0.00
Permit
PLUMBING
Additional desc .
Permit Fee . . . .
33.00 Plan Check Fee
8.25
Issue Date . . . .
Valuation
0
Expiration Date
5/12/08
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
LQPERM[T
Application Number 07-00002939
s----------------------------------------------------------------------------
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
LQPERM[T
L'
11/08/2007 13:12
7606749438
AMERICAN POOL CONST
PAGE 01/03
Bin
City of La ,Quanta
Building of Safety Division
P.O. Boz 1504, 78-495 Calle Tampka
4 Quizlta, CA 92253 - (760) 777-7012
Building Permit Application and racking Sheet
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