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13-0487 (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: 13-00000487 52903 ROSS AVE 767-670-018- -330761- POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 85000 Architect or TW!t 4 QlAk BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ------------------------------------------ LICENSED CONTRACTOR'S DECLARATION I hereby affiim under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business androfp�ssionals Code, and my License is in full force and effect. License Class: C53 A /► License No.: 6920W 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 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, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec. 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 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 ---- --- ,— VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/19/13 Owner: LOTHENBACH ROBERT J 1000 VALLEY PARK DR SHAKOPEE, MN 55379 Contractor: CAHUILLA POOL CONSTRUCTION INC P O BOX 2569 PALM DESERT, CA 92261 (760)396-5886 Lic. No.: 692059 ----------------------------------------------— 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 STATE FUND Policy Number 903291812 -�rcertify 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 su •ect to the workers' compensation provisions of Section s 3790 of the Labor Cod,I all fo h ith comply with those provisions. Date:'Ip 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 IS100,0001. 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 4trution, tion is correct. I agree to comply with all city and county ordinances and state laws relating to building con and hereby authorize representatives of this cou ty to nter upon the above-mentioned property r inpurposes. Date:. nature-( plicant or Agen Application Number . . . 13-00000487 Permit . . . . . . MECH POOL' Additional desc Permit Fee 26.00 Plan Check Fee 6.50 Issue Date . . . . valuation . . . . 0 Expiration Date 10/16/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 11.0000 ----------------------------------------------------------------------------- EA MECH FURNACE >100K 11.00 Permit. . . . . . . BLDG POOL PERMIT Additional-desc Permit Fee . . . . 572.00 Plan Check Fee.. 371.80 Issue Date valuation . . . . 85000 Expiration Date 10/16/13 Qty Unit Charge Per Extension BASE'FEE 414.50 35.00 4.5000 -------------------------------------------------------------- THOU BLDG 50,001-100,000 157.50 7 ---- Permit ELEC POOL PERMIT -RES Additional.desc Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date valuation 0 .Expiration Date 10/16/13 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 . . . . 81.00 Plan Check Fee 20.25 Issue Date Valuation . . . . 0 Expiration Date 10/16/13 Qty Unit Charge. Per Extension BASE FEE 15.00 8.00 6.0000 EA PLB FIXTURE 48.00 5.00 3.0000 EA PLB WATER INST/ALT/REP 15.*00 1.00 3.0000 EA' PLB GAS PIPE 1-4 OUTLETS ------------------------ 3.00 --------------------------------------------------- Special Notes and Comments 7 POOL AND SPA AT REAR YARD AND WATER LQPERMIT Application_Number . . . . . 13-00000487 ------- " Special Notes and Comments FEATURES -AT ENTRY AND SIDE YARDS [POOL ENGINEERING INC] THIS PERMIT DOES NOT INCLUDE EQUIPMENT WALLS OR FIRE FEATURES. SPECIAL DETAIL REQUIRED FOR ENTRY.WATER.FEATURE, To BE REVIEWED .IN FIELD. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2010 CALIFORNIA BUILDING CODE. April18, 2013-4:25:43' PM AORTEGA " -------------------_----------------------------------- Other.Fees . . . BLDG STDS ADMIN (SB1473) 3.00 Fee summary Charged Paid Credited. Due Permit Fee Total 724.00 .00 .00 724.00• Plan Check Total 409.80 .00 .00 409.80 Other Fee Total 3.00. .00 .00 3.00• Grand Total 1136.80. .00 .00 1136.80 LQPERMIT .. -