05-3662 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
,05-00003662
80360 VIA CASTELLANA
772-250-997-128 -31349 -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000
Tdtt 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am Ii censeckunder provisions of Chapter 9 (commencing with
Section 7000 1 Division 3 of the Busine nd Professi Is Codq, and�my License is in full force and effect.
License Cles : CFi3\%% kens o.: 56835
Date:
I hereby affirm under penalty of perjury that I am?xempt M1om the Con.kactor'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 ($5001:
(_ 1 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 contractorW 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
Owner:
JOHN BIRKKHEAD
80360 VIA CASTELLANA
LA QUINTA, CA 92253
Contractor:
VACATION POOLS INC
83900 AVE 45 STE C
INDIO, CA 92201
(760)775-0468
Lic. No.: 856835
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/23/05
`a U
AUG 2 3 2005
CITY OF LA QUINTA
------------------------------------------------
WORKER'S COMPENSATION DECLARATION
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 Pf the work for `yhich this permit is issued. My workers' compensation
insurance carrier and policy nu�jber are: A
Carrier
Date:
1795938-05
:rtify that, in th(;�nnsertso
a the work f this permit is issued, I shall not employ any
person in any a to me su ' c to th workers' compensation laws of California,
and agree that, hld b co su tl wor ers' compensation provisions of Section
3 0 f the La Code, I sal fo hw' h c wit those provisions.
WARNING: FAILURE -TO SECURE ORKERS' MPENYATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMII ALTIES 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 med under or pursuant to any pr it issued as a result of this application,
the owner, and the ap, each agrees to, and shall defend, in mnify and hold harmless the City
of La Quinta, its officents and employees for any act or omis 'on related to the work being
performed under or foissuance of this permit.
2. Any permit issued as of this application becomes null an void 'f work is not commenced
within 180 days fromo ' of such p mit, or cess. on of work for 180 days will subject
permit to can
I certify h t I have this apptind state that a ov 'nformation i c rect. I agree to comply with all
city o y i sand st relating to bu Ing n truction ereby authorize representatives
oft oun y �Pion the ab MP entioned propert for purp es.
Date: •,Signature (Apor Agent)
Application Number . . . ... 05-00003662
Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . . 26.00 Plan Check
Fee
6.50
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 2/14/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 11.0000 EA MECH FURNACE >100K
----------------------------------------------------------------------------
11.00
Permit BLDG POOL PERMIT
Additional desc.. .
Permit Fee . . . . 207.00 Plan Check
Fee
134.55
Issue Date . . . . Valuation
. . .
. 20000
Expiration Date 2/14/06
Qty Unit Charge Per
Extension
BASE.FEE
45.00
18.00 9.0000 THOU BLDG 2,001-25,000
----------------=----------------------=------------------------------------
162.00
Permit . . . ELEC POOL PERMIT -RES
Additional desc . .
Permit Fee . . . . 45.00 Plan Check
Fee
11.25
Issue Date Valuation
. . .
. 0
Expiration Date 2/14/06
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
8.25
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 2/14/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 6.0000 EA PLB FIXTURE
12.00
1.00 3.0000 EA PJ b WA'fEk 1NSIJALT/h'EP
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 BE
LQPERMIT
Application Number . . . . . 05-00003662
----------------------------------------------------------------------------
Special Notes and Comments
IN PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 311.00 .00 .00 311.00
Plan Check Total 160.55 .00 .00 160.55
d' Grand Total 471.55 .00 .00 471.55
LQPERMIT
AUCs -18-2005 09:04A FROM:UACATION POOLS INC 17607750469 TO:977770'1 P.1
Bin #City
of la QUlnta
DBuilding 8z Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit
Project Address: $ D 3
Q U
Owner's Name: T0hA'
A. P. Number:
Address:
Legal Description:
City, ST, Zip: kA*Y44-->
Contractor: QC
Address;g?79 00
L T l RXIG
6
Telephone::>k
4L4-
Project Description:
City, ST, Zip:
r'1 i15M
M YU 12
I -216d&
Telephone: b
;:::::`::;;
State Lie. # : 8
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
^s'>:::r,,::;::;;;r'<-`•.? :;:
Construction Type: Occupancy:
Project type (circle one): New Acd'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: CJd
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMIT I•'E.ES
Plan Sets
Plan Check submitted
$
Item
Amount
Structural Coles.
Reviewed, ready for corrections
Plan Ch<ck Deposit
Truss Cales.
Called Contact Person
Plan Ch;ck Balance
Title 24 Calcs.
Plans picked up
Construation
Flood phin plan
Plans resubmitted
Mechan,cal
Grading plan
21' Review, ready for corrections/issue
Electrical
Subeontactor List
Called Contact Person
Plumbieg
Grant Deed
Plans picked up
S.M.1.
H.O.A. Approval
Plans resubmitted
Gradint
IN 140USE:-
"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fecq
Total N -1 -mit Ices