07-0087 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
X07 -y000-00087
53347 VIA MALLORCA .
772-420-999-43 -298943=
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL.
30000
c&t!t -4'a(P Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
_ RON & SUE MOBLEY
305 S GENIUS LOCI
PAYSON., AZ 85541
M -It
Contractor:CF3
LUXURY.HOMES INC -
F35Fi
122 N. 2ND ST, A-404PHOENIX,
AR 85004(602)377-5102
LiC. No.: 874172
Date: 6/26/07
u
-
------------------------------- - - - - ------------------------------.-- - - - - -- --- —=- - - - - --
- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter (commencing with - I hereby affirm under penalty of perjury one of the following declarations: ,-
Section 7000) of Division 3 of the Business and Pr fessionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
LicensefClass, B License No.: 874172 for by Section 3700 of the Labor Code, for the performance of the workJor which this permit is
�//►► _ " issued.
Daily _ V TContractJk� m� — 1 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
OWNER -BUILDER D LARATION insurance carrier and policy number are: -
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ST. PAUL TRAVEL.. Policy Number 17859010
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit.to? _ I certify that, in the performance of the work for which this'permitis issued, I shall not employ any
construct, alter, improve, demolish; or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers" compensation laws of California,
• .. _ permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' -compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or ' _ 3700 of the Labor Code, I shVl forthwith comply with .cvisions.
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 ISec: 7044,_Business and Professions Code: The
Contractors' State License taw 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, 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.l.
I I I am exempt under Sec. , B.&P.C. for this reason .
Date: Owner:
CONSTRUCTION LENDING AGENCY
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:
LQPER.N1IT
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 county ordinances and state laws relating to building cons uction, and hereby authorize representatives
of this c my t nter upon the above-mentioned pr erty. for insp ction purpose .
"Date. `�-gnature (Applicant or Age _
Application Number . . . . . 07-00000087
Permit BLDG POOL PERMIT_
Additional' desc .
Permit Fee 284.50
Plan Check
Fee
184.93
Issue Date
Valuation
30000
Expiration Date .. 8/04/07
Qty Unit Charge Per
Extension
BASE
FEE
252:00
5_•00 6.5000 THOU BLDG
25,001-50,00.0
32.50
Permit MECH POOL
Additional desc .
Permit Fee . . . . 26.00
Plan Check
Fee
6.50
Issue Date . . . .
Valuation
0 ;
Expiration Date 8/04/07
Qty Unit Charge" Per
-Extension
BASE
FEE
15.00
1.00 11.0000 EA MECH
FURNACE >1:0OK
11.00
Permit ELEC POOL PERMIT -RES
Additional desc .
Permit Fee _ 45.00
Plan. Check
Fee
11.25
Issue Date _.
Valuation
0
Expiration Date 8/04/07
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 8/04/07
Qty Unit Charge Per
Extension'
BASE
FEE o.
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
LQPERMIT
LQPERMIT
JAN -09-2007 11:12 AM
L �
P.03
61a #
City of La Quinta
Building at Safety Division .
P.O. Box. 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 . (760) 777-7012
Building Permit Application and Tracking, Sheet
Peftnit #
07 017
Project Address. rj ?, -- ��'� V (h De('A
Owner's Name: &f4 4�� K4 (-)(4g9J
A. P. Number: ;R —' S
blas L cc_
Address: s S ..n ,
Legal Description: i 44 S9
Contractor: CP3
City, ST, Zip: ��N A 69�
Telephone - ep it, i
Address: 4 N !-SL1r1—
Project Description:
City, ST, Zip: figfNIX1649-�O*
V cep-, (C4 MI,0tJ
Telephone(M•34-- �1,
State Lic. # : ° $ '�}' City Lie, #:
Arch., Lngr., Designer; 0
Address: �QS 4j . a ,
City, ST, Zip:
Tcicphonexz .(� 4007,
State Lic. #:
Name of Contact Person: (61k
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. -Ft:
# Stories:
# Units:
Telephone # of Contact Persontos- L924 - 400r%—
Estimated Value of Project: 30 wo
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
-Submittal
Req'd
. Ree'd
TRACKNO .
PERMIT FEES
2
2
Plan Sete
Structural Calm. 4
2 5TW
)t M5 •
Plan Check submitted
Reviewed, ready f corrections
A9/07
L �
Item
Plan Check Deposit
Amount
Z
1 wnwa-tcv—_ 7e
Kwee 7,44,
Called Contact Person
j
Pian Check Balance
Energy Calm.
Plana picked apConstruction
Flood plain plan
Plana resubmitted
Mechanical
Grading plan
Subcontactor Llat
V
2°" Review, ready for correctlonstissue
Called Contact Person
Electrleel
Plumbing
Graat Doti
H.O.A. Approval
IN HOUSE:-
Planning Approval
Pub, Wks. Appr
Plans pleked up
Plana resubmitted
'"' Review, ready for correctionslissue
Called Contact Person
Date or permit Issue
S.M.I.
Grading
Developer Impact Fee
School Fees
'Total Permit Fees
14--� 40n- M
n
r ..
��
• OF LA
QUINT,A,....:._ .
APPROVEDFOR PROVED
J CONSTRUCTION
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