06-3240 (RPL)1.6
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoninq:
Application valuation:
06-00003240
53527 VIA DONA
772-420-999-40 -298944-
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
30000
T44t 4 4 Q"
Architect or Engineer:
.W Ik
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of pe ury t t I am licensed under provisions of Chapter 9 (commencing with
Section 7000 of Division 3 of the Busine s and Professionals Code, and my License is in full force and effect.
Licens ass: C53 License No.: 598681
r
ate: ntractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjur that I 'm exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and rofessions 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.).
(_) 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
( ) 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
JOHN HAYNES
53527 VIA DONA
LA QUINTA, CA 92253
Contractor:
AINSWORTH POOL CONSTR,
40900 GLENMORE DRIVE
PALM DB -ERT, CA 92260
(760)200-2800
Lic. No.: 598681
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/05/06
U �
B RT o f 0 d 2006
------------------
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,9 licy number are:
Carrier CALIF INS Policy Number 460030110102
_ I certify that, in the p forma ce of the work for which this permit is issued, I shall not employ any
person in any man er so a to beco a subject to the workers' compensation laws of California,
and a ree that, if I hould eceme b'e o the orkers' compensation provisions of Section
13700ofthe Labor ode, I hall th 1 th comply Nith those provisions.
Date: cantv
: T_ v
WARNING: FAILURE TO SECURE W R ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,000). IN ADDITION'10 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 at th bove inf rmati is co ect. I agree to comply with all
City and court rdinances and state laws relatin ant
g cons cti ,and her y authorize representatives
of this c t , ter upon hove-mentione property or ins ,e ti purposes.
(Applicant or
Application Number . . . . . 06-00003240
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 284.50 Plan Check Fee 184.93
Issue Date . . . . Valuation . . . . 30000
Expiration Date 3/04/07
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 . . 3/04/07
Qty Unit Charge Per Extension
BASE FEE 15..00
1.00 11.0000 EA MECH FURNACE >100K 11.00
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Permit . . . ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation . . . . 0
Expiration Date 3/04/07
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 3/04/07
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
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
LQPERn1IT
Application Number
06-00003240
----------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary . Charged
----------------- ----------
Permit Fee Total 388.50
Plan Check Total 210.93
Grand Total 599.43
LQPERMIT
Paid Credited Due
---------- ---------- ----------
.00 .00 388.50
.00 .00 210.93
.00 .00 599.43
Big#
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracldng Sheet
Permit #
Project Address: U^
OrR'
Owner's Name: Wtv M wv�5
A. P. Number:
Address: % (RA t.,,A
Legal Description:
City, ST, Zip: to �CAT,11 n CP O) l ^
Contractor: SNSW� �( NS�R(n�T+duJ
Telephone:
~��
�? s:;
Address: y6 _y 60 V.
Project Description: #00t ONLY
City, ST, Zip:
A(, r- is G
Telephone:
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:a� K
State Lic. #:
Name of Contact Person: N65
Construction Type: occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
ll
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
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
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
d'd 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 Fees
IVID Ub 4y t
°moo❑❑�
F -10
000
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