07-0644 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
;07 -"00000644 --
Property Address:
56793 VILLAGE "DR
APN:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning: _
LOW DENSITY RESIDENTIAL
Application valuation:
5000
Applicant:
r
Architect or Engineer:
P/P
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
RUSTOM
56793 VILLAGE DRIVE
LA QUINTA, CA 92253
Contractor:
MCRAE POOL & SPASI
79105 DESERT STR
LA QUINTA, CA 92 5
(760)772-2440
Lic- No.: 823017
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
MqR �S ?DO
Date: , 3/01/07
-----------------------------------------------
. LICENSED CONTRACTOR'S DECLARATION'
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that.I am licensed under provisions of Chapter 9 (commencing with
1 hereby affirm under penalty of perjury. one of the following declarations: "
Section 7000) of Division 3 of the Business and Professionals 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
License Class:. C 3-C2.7 License No.: 823017.
_
for by Section 3700 of.the Labor Code,for the performance of the work for which thispermit is
/! /tel
ntractor: !/�' /� (/V
.
issued.
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 -BUILD DECLARATION
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
CarrierEXEMPT Policy Number EXEMPT
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 permit is issued,.) 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 mariner 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
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
3 0 of the Labor Code, I shall forthwith comply with tho 'provisions.
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
2"'j/.�
te: cant:
(_ 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
WARNING: FA RE TO SECURE WORKERS' COMPENSA ION COVERAGE IS UNLAWFUL, AND SHALL
' . Contractors' State License Law.does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
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.).
APPLICANT ACKNOWLEDGEMENT
1 _) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth,on this application. .
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). ' '
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ I I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
Date:
Owner:
- - - - CONSTRUCTION LENDING AGENCY . - -
4 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: PV
LQPERMIT
of La Quima, 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 andcountyordinances and state laws relating to building construction, and hereby authorize representatives
of this ty t enter upon t bove-mentioned' property for inspection purposes.
t �� ignm0re (Applicant or Agent): - '
ApplicationNumber . . 07-00000644.
Permit BUILDING PERMIT
T
Additional desc'.
Permit -Fee . . . 72.00 Plan Check.Fee
46.80
Issue Date . . Valuation
5000
'Expiration Date 8/28/07
. -Qty`" ---Unit 'Charge __-Per -
BASE"FEE
45.00 -
3.00 9.0000 THOU BLDG 2,001-25,000.
27.00
Permit ELEC-.MISCELLANEOUS
Additional'desc .
Permit Fee 17.25 Plan Check Fee
4.31
Issue Date. Valuation . . .
. 0
Expiration Date.. 8/28/07.
• Qty Unit Charge Per
Extension
r BASE FEE
15.00.
3.00 .7500.•PER ELEC DEVICE/FIXTURE 1ST 20
2.25
-------•------------------------------
Special Notes and Comments
------------
BBQ/FIREPIT, PER APPROVED PLANS
-------------------------------------------------.----------
Other Fees . . . . . ENERGY REVIEW FEE
---------
4:68
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited
Due
---------- ----- ---------------
Permit Fee Total 89.25 .00 .00:.
89.25
Plan Check Total 51.11 .00 .00
51.11 -
Other Fee Total 5.18, .00 .00
5.18
Grand Total 145.54 00 :00
145.54
Bin #
y� City of La Quinta
P . Building & Safety Division
Pemtic # , ` P.O. Box 1504, 78-495 Calle Tampico
j „ice La Quinta, •cA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address.` 7� - -293
A' (= Owner's Name: �/�
A. P. Number:
Address: r
Legal Description: t Z ' '
' City, ST, Zip:
Contractor: � �� _ t'
Address: 7 I O0
City, ST, Zip:
Telephone:
State Lic. # : O�
Arch. En9r., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Coles.
Truss Coles.
Energy Coles.
Flood plain plan•
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
= ;:z ,.Ab
L 1-11 v y 1, Project D/esc�rintion:
ITY OF LA QUI
Lic. #:
r
—
Construction Type:
Occu an
P cY:
Project type (circle one):
New Add,n Alter
Repair Demo
Sq. Ft.:
#
Stories: #
nits:
Estimated Value of Project: (�4/
Aln-rj
APPLICANT;
DO NOT WRITE BELOW THIS LINE
TRACKING
qRd..
,
7PIauheck
PERMrr
FEES
submitted 1/25
Item
Amount .
Reviewed, ready rrectioos
Ilan Check Deposit
Called Contact Person
Plan Check Balance
Pians picked up
Construction
Q
Plans resubmitted
Mechanical
2'' Review, ready for correcdoos mue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.L
Plans resubmitted
PITY
i
Review, ready for. correctionsPissue UILDI
Called Contact Person
JI&
Date of permit issue O
C(')KI