05-5493 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tihf 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 05 -00005493 -
Property Address: 52265 VIA CASTILE
APN: 772-410-998-11 -32453 -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C8 C27 C29� License No.: 656128
Date: �Contra cE�-r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury t at I am on 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, 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
pwperty VVIIU hUIIJa U1 Iwpiuveb tll@IeUil, mai wiw Uunuautb tui uIe piUleuts wen a UUM18CtUIIV) nuenseu
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:
LQPERMIT
Owner:
ND LA QUINTA PARTNERS
375 N FRONT ST STE 200
COLUMBUS, OH 43215
Contractor:
CALIFORNIA POOLS & SPAS
P.O: BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
------------------
WORKER'S COMPENSATION DECLARATION
Date: 12/19/05
DEC 212005
LA
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.
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 INS Policy Number BB1050510
_ 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 become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall with comply with those provisions.
Date: _28^6 Applicant: /—
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. 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.
I . eaun persue upon whose oenair tnls application Is maae, eaen person at whose request ano Tor
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 c y ordinances and state laws relating to building construction, and hereby authorize representatives
of this unty to enter upon the above-mentioned property for -inspection purposes.
Date: f7'Zl`P_*Tgnature (Applicant or Agent):
Application Number . . . . 05-00005493
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . 72.00 Plan Check Fee 46.80
Issue Date Valuation . . . . 5000
Expiration Date 6/17/06
Qty Unit Charge Per Extension
BASE FEE 45.00
3.00 9.0000 THOU BLDG 2,001-25,000 27.00
----------------------------------------------------------------------------
Permit . .
Additional desc .
Permit Fee . . .
Issue Date . . .
Expiration Date .
ELEC-MISCELLANEOUS
16.35
6/17/06.
Plan Check Fee
Valuation . .
4.09
0
Qty Unit Charge
Per
Extension
Extension
BASE
FEE
15.00
3.00 .4500
----------------------------------------------------------------------------
EA ELEC
DEVICE/FIXTURE >20
1.35
Permit . . .
PLUMBING
3.00
----------------------------------------------------------------------------
Special Notes
Additional desc . .
BARBEQUE Z21-55-1995
Permit Fee . . . .
24.00
Plan Check Fee
5.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . . 6/17/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00
6.0000 EA
PLB FIXTURE
6.00
1.00
3.0000 EA
PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes
and Comments
BARBEQUE Z21-55-1995
AND FIREPIT
AGAL
496.
----------------------------------------------------------------------------
Other Fees
ENERGY REVIEW FEE
4.68
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
LQPERMIT
Charged Paid
112.35 .00
56.14 .00
4.68 .00
173.17 .00
Credited Due
.00 112.35
.00 56.14
.00 4.68
:00 173.17
Bin # ,
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
ILa Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Os— ov
Project Address:(P15- U
A. P. Number:
Owner's Name:
Address:
City, ST, Zip:
Legal Description:
Contractor`. `
Address: 2
Telephone: w
Project Description:
City, ST, Zip: - 9'2_2
Telephone: 7lo6 '59 ?-(7, 2—
State
State Lie. # : 05& i 2— City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: -
State Lie. #:
Name of Contact Person: aG�� Je SS
Construction Type: Occupancy:
P cY:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: Q
#Stories:
#Units:
Telephone # of Contact Person:2,g0--�Iy2 - 7$101
Estimated Value of Project:
APPLICANT:
p0 NOT WRITE BELOW THIS LINE
l
Req'd
Recd
TRACMGYEZIVIIT
FEES
Plan Check submitted
�
Item
Amount
al Calcs.Reviewed,
FEnergy
ready for corrections
Plan Check Deposit
lcs.
Called Contact Person
Plan Check Balance
Calcs.
Flood plain plan
Plans picked up
Plans resubmitted
Construction
Mechanical
607*8
Grading plan
2nd Review, ready for correctionsliissue
Electrical 41
3 textu s
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
O /s 0
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'" 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 Fees
Total Permit Fee.: