06-1159 (SOTB)I
P.O. BOX 1504 Tihf. 4 VOICE (760) 777-7012
78495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
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 Division 3 of the Business and Pr fessionals Code, and my License is in full force and effect.
License Class: CB C27 C29 License No.: 656128
ate: 22 Contractp/
OWN _BUILDER DECLARATION
1 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 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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 1 1 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.I.
Lender's Name: _
Lender's Address:
LQPERMIT
----------------------------------------------—
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 HRH INS Policy Number BB1060510
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 bec me subject to the workers' compensation provisions of Section
3700 of the Labor Code, I sh orthwith comply with those provisions.
• ��' AppllcanT:
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 1 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 building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for ins a tion purposes.
Date: Z^ Signature (Applicant or Agent): /
Date: 3/22/06
Date:
Q
of
�
Application Number:
06-00001159 81 ' -
' Owner:
Property Address:
AVIA LA SERENA 140
4tA%•/� OTT
APN:
767-200-011-38 -318741-
if -06 K. 14. 81-945 VIA LA SERENA
Application description:
STRUCTURES OTHER THAN BUILDINGS
LA QUINTA, CA 92253
Property Zoning:
Application valuation:
LOW DENSITY RESIDENTIAL
15000
. _.
D
Armlicent:
Architect or Engineer:
Contractor:
CALIFORNIA POOLS & SPAS
MSR 2 �0�6
P.O. BOX 1280
COACHELLA, CA 92236
CITY OF LAwulo. ik
y.J /W
(760)398-9222
FINANCE CEP16-
Lic. No.: 656128
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 Division 3 of the Business and Pr fessionals Code, and my License is in full force and effect.
License Class: CB C27 C29 License No.: 656128
ate: 22 Contractp/
OWN _BUILDER DECLARATION
1 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 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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 1 1 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.I.
Lender's Name: _
Lender's Address:
LQPERMIT
----------------------------------------------—
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 HRH INS Policy Number BB1060510
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 bec me subject to the workers' compensation provisions of Section
3700 of the Labor Code, I sh orthwith comply with those provisions.
• ��' AppllcanT:
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 1 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 building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for ins a tion purposes.
Date: Z^ Signature (Applicant or Agent): /
Application Number . . . . . 06-00001159
Permit . . .
BUILDING PERMIT
Additional desc . .
Permit Fee . . . .
162.00
Plan Check Fee
105.30
Issue Date . . . .
Valuation . . .
. 15000
Expiration Date
9/18/06
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
13.00 9.0000
----------------------------------------------------------------------------
THOU BLDG
2,001-25,000
117.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . .
17.25
Pian Check Fee
4.31
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
9/18/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
3.00 .7500
----------------------------------------------------------------------------
PER ELEC
DEVICE/FIXTURE 1ST 20
2.25
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
18.00
Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
9/18/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
BARBEQUE (Z21-58-1995).
----------------------------------------------------------------------------
Other Fees . . . . .
. . ENERGY REVIEW FEE
10.53
Fee summary Charged
-------------------------------------
Paid Credited
--------------------
Due
Permit Fee Total
197.25
.00 .00
197.25
Plan Check Total
114.11
.00 .00
114.11
Other Fee Total
10.53
.00 .00
10.53
Grand Total
321.89
.00 .00
321.89
LQPERMIT
Bin #
City of. La Quinta
Building a Safety Division
Permit' # P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:,F 1-9V57 V ic.,, tC, a>eC., Owner's Name:
A. P. Number:
Address: •e -S
Legal Description:
City, ST, Zip:1 k_,? L`S v i c, c S_t! e � �
Contractor.`:. - .
—TA. -
Address:
_
Address: �PQ
iZ CP Project Description:
City, ST, Zip . C� . l 2-Zl 2.2 t q C
Total Permit Fees
DATE BY_S.I�
Telephone:
009
State Lic. #: Z
City Li,. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): Add'n Alter Repair
Demo
Sq. Fit:
# Stories:
# Units:
Telephone # of Contact Person: pZSQ— C1 C12 Estimated Value of Project: �� O C)
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted L
`0
Item
Amount
Structural Calcs.
Reviewed; ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Flobd plain plan
Plans picked up
Plans resubmitted
Construction
Mechanical
TB
Grading, plan
Subcontactor List
Grant Deed
2°" Review, ready for correctionsfissue
Called Contact Person
Plans picked up
Electrical
Plumbing `Yz
3 — F'iKT�JLE$
owl ETS
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
Developer Impact Fee
IN HOUSE:-
'"' Review, ready for corrections/issue
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
OF (_A Q U I NrA
BUILDING & SAFETY D
Total Permit Fees
DATE BY_S.I�
CALIFORNIA POOLS a SPAS
86-100 Ave. 54, P.O. Box 1280 • Coachella, CA 92236 • (760) 398-9222 • Fax (760) 398-9255 • Ca. Lic. No. 656128
June 13, 2006
City of La Quinta
Building Department
78-495 Calle Tampico
La Quinta, CA 92253
To Whom It May Concern:
The following is a request to change the address on Permit# 06-00000335 and #06-
00001159, to 81-900 Via La Serena Lot 27 Carmella. (Wrong address on permit.)
If you have any questions please call the office at 398-9222.
Thank you,
California Pools as
k6berf K. mit
President
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