05-3979 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: C05-0 00 03-979j
Property Address: 53697 VIA DONA
APN: 772-420-999-35 -298944-
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 30000
Applicant: Architect or En
Td�v °F 4 Q"
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
SEP 2 7 2005
cry OE
LICENSED CONTRACTOR'S DECLARATION �G
I hereby affirm under penalty o�Businesr.nd
I am ice ed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of rofe sionals Code, and my Lice se is in full force and effect.
Li fiseC ss: License No.:
/ Date: .contrac
\fj OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that m 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).:
(_) 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 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 contractg fQr the, nrnjortr ,.,Ith a ao.-a,u tuiisl nuensed
purwant to the rnn:rew@ro' Otuie LILenSe 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: 9/13/05
-
Owner:
INGSTER
53-697 VIA DONA
LA QUINTA, CA 92253
Contractor:
CAHUILLA POOL CONSTRUCTION INC
WCC: STATE FUND
WC: 0010153-2005 01/01/06
CSLB: 692059 07/31/06
--------------------------------------------—
WORKER'S COMPENSATION DECLARATION
I h rely 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 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 b comJ
ubject to the workers' compensation laws of California,
and agree that, if I should co suct to the workers' compensation pr visions of Section
+11ILROE
ft a Labor Code, tall orthh comply with those provisions.
e: pplica t:
WARNIN O SECURE WORK' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE 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 Bmildina and Safety fef o aubjeut to tna
wrlditinns and rnrtfwtisna a6l IVI th un MIS 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 county ordinances and state laws relating to buil ing constru�ses.
rize representatives
of this co y to ter upon the above-mentioned prope for inspec
Da "9gnature (Applicant or Agent
Application Number 05-00003979
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
284.50 Plan Check Fee
184.93
Issue Date . . . .
Valuation . . .
. 30000
Expiration Date
3/12/06
Qty Unit Charge
Per
Extension
BASE FEE
252.00
5.00 6.5000
---------------------7------------------------------------------------------
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 . .
3/12/06
Qty Unit Charge
Per
Extension
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 .- .
3/12/06
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 . .
3/12/06
Qty Unit Charge
Per
Extension
BASE FEE
15 40
2.00 6.0000
EA PT.R FIXTURB
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 ONLY. ALARMS/BARRIERS SHALL
LQPERMIT
ci
Application Number . . . . 05-00003979
sd
----------------------------------------------------------------------------
Special Notes and Comments
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid Credited Due
----------------=----------------------------------------
Permit Fee Total 388.50 .00 .00 388.50
Plan Check Total 210.93 .00 .00 210.93
Grand Total 599.43 .00 .00 599.43
LQPERMIT
Bin #
---- —
City of La Quinta
--- —---Building`SrSafety-Division _ --
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Trzcking Sheet
Permit #
05- 3
Project Address: 5509 VIA PON)A-
Owner's Name:
A. P. Number:
Address:
Legal Description:
Contractor: CA4�A t LA -A- PVO(— "�
City, ST, Zip: Wl 17JT4- (A .
Telephone:
Address: Q�x 2�`�' 1
Project Description:
City, ST, Zip: �Sl✓�I lM
!Jt/� i� •1� �'�' /`t'
Telephon "ZIOd) +)0 '`,6131
State Lic. #
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: (gWt -j'1E:v Occupancy:
Project type (circle one): ew Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person: SIM
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: Zbo 4093-Qj
Estimated Value of Project- -jU 000', CC)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'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
Con-3ruction
Flood plain plan
Plans resubmitted
Meebanical
Grading plan
2"d Review, ready for corrections/issue
Electical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M. _.
H.O.A. Approval
Plans resubmitted
Gracing
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
=L
Total Permit Fees
Li ter. 1 1
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