06-3571 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoninq:
Application valuation:
Applicant:
06-00003571
78925 "VIA CARMEL
646-400-0307 - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
25000
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ERB
78925 VIA CAR
LA QUINTA, CA
VOICE (760) 777-7012
, FAX (760) 777-7011
INSPECTIONS (760) 777-7153
I 0o" 12- 211,
Contractor: ICITY
CALIFORNIA POOLS & �
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
Date: 10/10/06
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L, ENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION "
hereby affirm under penalty of perjury that 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 Busine ofessionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class CP C27 C License No.: 656128
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/
ate: �l IP ontractor:
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
0NER-BUILDER DECLARATION
insurance carrier and policy number are:
hereby affirm under penalty of perjury that I am e�empt from the Contractor's State License Law for the
Carrier SEABRIGHT Policy Number BB1060510
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
work for which this permit is issued, I shall not employ any -
_ I certify that, in the perfoJaso
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner me subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I shoubject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
100 of the Labor Cohwith comply with those provisionsthat
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 (5500).:
plicant:
(_) 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
WARNING: FAI RE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors'.State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PEN TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
- (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 .- Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). -
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
I
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:
LQPERn4IT
of La —inta, its officers, agents and employees or 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 app*cot
null and void if work is not commenced
within 180 days from date of issuance r cessation. of work for 180 days will subject
permit to cancellation.
I certify that II have read this application and state thation is correct. I agree to comply with all
city and co 4y ordinances an •state laws relating tocti and hereby authorize representatives
of this con to /iter po eabove-mentioned prtion p rposes. . .
Date: �/ nature (Applicant or Agent):
Application Number . . . . 06-00003571
Permit . . . . BLDG POOL PERMIT
Additional desc .
Permit Fee 252.00 Plan Check Fee
163.80
Issue Date . . . Valuation .
. 25000
Expiration Date 4/08/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
23.00 9.0000 THOU BLDG 2,001-25;000
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207.00, _
Permit . . . MECH POOL
Additional desc .
Permit Fee 26.00 Plan Check Fee
6.50
Issue Date Valuation-
0
Expiration Date .. 4/08/07
Qty Unit Charge Per
Extension
J
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 4/08/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 30.6000 EA. ELEC PRIVATE SWIMMING POOL
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30.00
Permit . . PLUMBING
Additional desc .
Permit Fee . . 33.00 Plan Check Fee
8.25
Issue Date . . . Valuation . . . .
0
Expiration Date 4/08/07
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
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Special Notes and Comments
POOL/SPA, WATER FEATURE.
LQPERMIT