05-4503 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t!t44Q"
Application Number: r5-00004503
Property Address: 52'445—VIA-CASTILE
APN: 772-410-998-23 -32453 -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 9000
Applicant:
Architect or Engineer:
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 7000) of Divisi f the Business and Professionals Code, and r, Lic�nsQ,.is in fyll fgrce and effect.
License Class: License No.:
ate:ontract
r.
OWNER -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).:
(_ 1 1, 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 _ 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.).
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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760).777-7153
Date: 10/06/05
Owner:
ND LA QUINTA PARTNERS
375 N FRONT ST STE 200
COLUMBUS, OH 43215
Contractor:
CALIFORNIA POOLS & SPAS
WCC: SEABRIGHT INS
WC: BB1050510
CSLB: 656128
01/01/06
10/31/06
------------------
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 C8 C27 C29 C53 Policy Number - - - - - - - - - - - - - --
_ 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 forthwith comply with those provisions.
at1Pl e: 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 ($100,000). 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 o I ty ordinances and state laws relatinFproy.
ng construction, and hereby authorize representatives
of thi ounty to enter upon the above-mentioned for inspection purposes.
Date: Signature (Applicant or Agent):
m
Application Number . . . . . 05-00004503
Permit . . .
BUILDING PERMIT
Additional desc . .
Permit Fee . . . .
108.00 Plan Check Fee
70.20
Issue Date . . . .
Valuation . . .
. 9000
Expiration Date
4/04/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
7.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
63.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . .
16.35 Plan Check Fee
4.09
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
4/04/06
Qty Unit Charge
Per.
Extension
BASE FEE
15.00
3.00 .4500
----------------------------------------------------------------------------
EAELEC DEVICE/FIXTURE >20
1:35
Permit . . .
PLUMBING
Additional desc . .
Permit Fee
24.00 Plan Check Fee
5.25
Issue Date . .
Valuation . . .
. 0
Expiration Date
4/04/06
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 #Z21-58-1995
AND AGAL 496 ONLY.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ENERGY REVIEW FEE
7.02
Fee summary Charged Paid Credited
Due
---------------------------
Permit Fee Total
------------------------------
148.35 .00 .00
148.35
Plan Check Total
79.54 .00 .00
79.54
Other Fee Total
7.02 .00 .00
7.02
Grand Total
234.91 .00 .00
234.91
LQPERMIT
Bin #
City of La Quints
Building 81 Safety. Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1&05
Project Address: �,2 C/% S V ' -� `
Owner's Name: �.AJ A
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor JDAS J
Telephone:
Address:V-d. aox \ 2--,F) o
Project Description:
City, ST, Zip: Cts C C�• �(O
Telephone 7�,Z
L
State Lic. #: (gyp p2
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add's Alter Repair Demo
State Lic. #:
Name of Contact Person: �1G� f?
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: iZ lltli, 5 7757' 02V
Estimated Value of Project: Q p C)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
'
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
S'p (3
Flood plain plan
-Banns-resubmitted
Mechanical
Grading plan
CJT1P
2"J$eviesv1reaiiyifo�corcec_tiA4rs ue
Electrical
3_ �1ET�p.ES
Subcontactor List
BU '�`Va�l�ed�Coonact�PPlson��
Plumbing
Grant Deed
�
rPlK �icl> C
a r`� tpX w u ! TA
S.M.I.
H.O.A. Approval
,Plans resubmitted
Grading
IN HOUSE:-
DAT!_'—`"
Revicw,Rady f—rreefions%si i te
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permi: Fees