05-5585 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Applicmion —iluaticn;
Applicant:
/05-00005585 j
("80825 VISTA BONITA TR
772-280-018- -
POOL - RESIDENTIAL
VERY LOW DENSITY RES
35000
Architect or Engineer:
.44.1
_ -------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SAUTER FAMILY
80-825 VISTA
LA QUINTA, CA
I hereby affirm under penalty of perjury that I am licensed and r provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busines nd Professional Code, and my License is in full force and effect.
License Class: C53 'cense No.: 841981
ate: %z -W 05 Contract
a=
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).:
(_ I 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.).
1 _ 1 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.).
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
TRUST
BONITA TRAIL
92253
)ntractor:
& R COMPLETE
.O. BOX 103
POOL SERVICE
A QUINTA, CA 92247
[760)772-0752
Lic. No.: 841981
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/29/05
----------------------------------------------
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.
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
insurance carrier and policy number are:
Carrier YOUNGEILOND INS Policy Number 229003025105
I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
person in any manner so as t become subject to a workers' compensation laws of California,
and agree that, if I should borne subject to the orkers' compensation provisions of Section
3700 of the Labor Code, I rail fo with comp with t se provisions.
Deft: r " Applicants
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.
1 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 construction, and her by aut orize representatives
of this count o-eriter upon the above-mentioned property for i ec 'on purpose .
Dat Signature (Applicant or Agentl:
CITY OF LA QUINTA SUB=CONTRAPTOR LIST
JOB ADDRESS—g1S l PERMIT NUMBER 0S- 559? OWNER Da -,w _r BUILDER �" w
This'form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
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-136 1.6 &
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Application Number . . . . . 05-00005585
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee. . . 317.00 Plan Check Fee 206.05
Issue Date . . . . Valuation . . 35000
Expiration Date.. 6/27/06
Qty Unit Charge Per Extension
BASE FEB 252.00
10.00 6.50uu THUU BLDG 25,001-50,000 65.00
----------------------------------------------------------------------------
Permit . . . MECH POOL
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date 6/27/06
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 . 6/27/06
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 6/27/06
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. ALARMS/BARRIERS SHALL BE IN
LQPERMIT
Application Number . . . . . 05.-00005585
-----------=---------------------------------------------=------------------
Special Notes and Comments
PLACE PRIOR TO PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED IN
PERMIT.
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 421.00 .00 .00 421.00
Plan Check Total 2"12.,n5 ,nn .00 232.05
Grand Total 653.05 .00 .00 653.05
LQPERMIT
Bin #
City of La Quints
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: V1-,)+a "� t l % A-v4
Owner's Name:
A. P. Number:
Address: 80 9,,� 5
City, ST, Zip: ( -� 0171z,�-3
Telephone.
Legal Description:
Contractor: A
Address: `% o X
/�
Project Description: /Ue0j Poo 1 d- 5 A 1AJ I
City, ST, Zip: Ll I n 9 o& (4 --1
I � i D S
Telephone: (OD % 7 '0 7 S
ISE i g t 1 VJ 14-h OLAA
/�JQ b eck rI O r
CSC— bQi'J1c bL4 C
State Lic. # : S 4 City Lic. #: )14 S
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: Rot-4 VA Z
Construction Type: O. cupancy:
Project type (circle one):ew Add'r Alter Repair Demo
Sq. Ft.:
Stories:
# Units:
Telephone # of Contact Person: '7a-7
Estimated Value of Project: 35,000
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
,Z j�0
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check L•eposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" 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
Total Permit F--es
.�.^ _ 1 ` , .• I _ � � \ 1.
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PAD = 98.80 1
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