05-1956 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO -
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
05-00001956
5638'5"VIt IGE DR
764-040-008- -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
15000
M
Applicant: Architect or Engineer:
' y
4
BUILDING & SAFETY'DEPARTMENT,
BUILDING PERMIT
Owner:
MAY ?, 5X005
CITY OF LA 01jlu,._
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 Profession Code, and my License is in full force and effect.
-✓ License Class: ii License No.:2_ (,
ate:' ContractoC/ iblC' 12.,t/ A
OWNER -BUILDER DECLARATION
I 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 ownemployees, 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 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 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
ROWNSON
6-385 VILLAGE DRIVE
A QUINTA, CA 92253
Contractor:
MCRAE POOL & SPAS
WCC: EXEMPT
WC: EXEMPT
CSLB: 823017
VOICE (760) 777-7012
FAX (760) 777-7011 r
INSPECTIONS (760) 777-7153
Date: 5/20/05
09/30/05
08/31/05
-------------7---------------------------------
WORKER'S COMPENSATION DECLARATION -
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: -o. `
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 become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the LaborCode, I shall forthwith. comply with those provisions.
- 2 t/ O_�_ApplicanV-/Z
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 (5100,000). 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
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 a6d•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
o his county to enter upon the above-mentioned propeer/W.�for inspection purposes.
Dams 2 /0J Signature (Applicant or Agentl:
Application Number . . . . . 05-00001956
.Permit . . BLDG POOL PERMIT'._•
Additional desc .
Permit Fee 162.00 Plan Check Fee
105.30
Issue•Date Valuation
15000
Expiration Date 11/16/05
Qty Unit Charge Per
Extension
BASE FEE
45.00
13.00 9..0000.THOU BLDG 2,001-25,000
117.00
Permit MECH POOL
Additional desc .
Permit Fee. . 26.60 Plan Check Fee-.
6.50
- Issue Date Valuation; ."
0
Expiration Date -.." 11/16/05
-
Qty Unit -Charge Per
Extension
- BASE FEE
15.00
1.00 11.0000 EA MECH FURNACE.>i00K
11.00
Permit . . . ELEC POOL PERMIT -RES
Additional'desc .
- Permit Fee 45.00 Plan Check Fee
,11.25
Issue Date Valuation . . .
0
Expiration Date .11/16/05
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, 11/16/05
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 ONLY.-ALARMS/BARRIERS SHALL
BE IN PLACE PRIOR TO.PRE-PLASTER
" INSPECTION. EQUIPMENT ENCLOSURE NOT
LQPERMIT -
' Application Number . . . . •
.05-00001956
-- - - -- -- - - - - - - - - - - - - - ------ - -- - --
Special Notes and Comments
-----
' INCLUDED IN PERMIT.
Fee summary Charged
Paid,
Credited
-Due
Permit Fee Total 266.•00
.00
.00 _
266.00
Plan Check Total. 131.30
_00
00
131.30
Grand Total 397.30
.00
.00
397.30
LQPERMTT
CITY OF LA QUINTA SUB -CONTRACTOR I IRT �llr_
JOB ADDRESS �G �3gs V )l 1�4(,E PERMIT NUMBER _ OWNER BUILDER_ M�4c P001�'
This form shall be posted on the job with the BtlildiMlnSDection Card at all times in a cons-icuous place. Only persons appearing on this list or their employees are authorized�to; &ork
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Fail a to comply will result in a sto a " e of work and/or the voidance
of building hermit. For each annlirnhip traria all infnrmntinn ram onctnrl k-1-- "'V pp g
Trade / Classification
Contractor
- - - - - -- - -- .r•—
State Contractor's License _
�-� •-rr• vva. �.,,auvw v�Nvwc.
.HNorkers Com ensation Insurance �'"
City Business License
Company Name
Classification .
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx!xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format'Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK IC -12) d
C cAJ ► �A�f
O %
(2.I�-O.S
UN
O G O S�
- D -O
�S 33
3 3�-Cl-5--
CONCRETE (C-81
C
FRAMING (C-5)
STRUCT. STEEL (C-51
- Z/y 7 7
MASONRY. (C-29)
PLUMBING (C-36)
LATH, PLASTER (C-35
SU
C—,53-
726970
10-1-o7
S-1A
�=Q
o
og
2-. v�
DRYWALL (C-9)
HVAC (C-20)
ELECTRICAL (C-10)
c — 2'
g
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w
S
2
1
'3 /�
1
ROOFING (C-39) .
SHEET METAL (C-43)
FLOORING (C-15)
GLAZING (C-17).
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING (C-38)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
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