07-3181 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4hf 4 4 a"
Application Number: 07-00003181
Property Address: 77886 GREY WOLF TR
APN: 658-140-999-92 -29436 -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1500
Architect or Engineer:
0(P
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSE NTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I a icense under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business a Professio als Code, d y License is in full force and effect.
Licensed Class: /C53 License N 8681
Cont tor
I hereby affirm under penalty of perjury that I OW R -BUILDER DECLARATION
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, 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 (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 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
Owner:
ROBERT AINSWORTH
77886 GREY WOLF TRAIL
LA QUINTA, CA 92253 1FD
Contractor:
AINSWORTH POOL CONSTR,
40900 GLENMORE DRIVE
PALM DESERT, CA 92260
(760)200-2800
Lic. No.: 598681
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/20/07
--� u
DEC 2 0 2007
C� L - A Qt91NTA
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 CALIF INS y Number 460030110103
I certify that, in the performan of the ork for which this permit is issued, I shall not employ any
person in any manner so a 'to become ubject to the workers' compensation laws of California,
nd agree that, if I should ecome subje t to the workers' compensation provisions of Section
1700 of the I shAll forthwa corrUply with those provisions.
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 tate that a above informa on is correct. I agree to comply with all
city and county ordinances an ws lating to bu ding constructs hereby authorize representatives
oft is c unty to enter upon t e bove-m tione prop ty for inspe o pa poses.
D / Si tur ppkcant Ag
Application Number . . . . 07-00003181
Permit . . . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 35.00 Plan Check Fee 22.75
Issue Date . . . . Valuation . . . . 1500
Expiration Date . . 6/17/08
Qty Unit Charge Per Extension
BASE FEE 15.00
10.00 2.0000 HND BLDG 501-2,000 20.00
-------------------------- -----------------------
Special Notes and Comments
PRE -CAST PUMP VAULT FOR POOL EQUIPMENT,
PER APPROVED PLANS
------------------------------------------
Other Fees . . . . . . . . . ENERGY REVIEW FEE 2.28
STRONG MOTION (SMI) - RES .50
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
LQPERMIT
Charged Paid
35.00 .00
22.75 .00
2.78 .00
60.53 .00
Credited Due
.00 35.00
.00 22.75
.00 2.78
.00 60.53
Bin #
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1
Project Address: �j j
Owner's Name:
A. P. Number:
Address:
Legal Description:
Contractor:
City, ST, Zip:
Telephone: , Y
Address:
Project Description:
City, ST, Zip:
FLA p�-�,? V1 (-
Telephone:
State Lic. # : City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: : ; ' : `•.
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
eJ
Estimated Value of Project: —
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
" 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 Fees
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TO/TO 39Vd IIA Ainiin LELCBZ0606 80 =ZT L00Z/LI/ZT
12/17/2007 11:20 9094283737 UTILITY VLT
Ed —16 f " " U6�e4
1"0 Pick Holes
6" Top W/ 2'-6" x
RPM
2 Ton Swiftlifts
2 Ea. Side Wall
4 Total
2'-6" x 4'-0" Base
3'-2'
- 2'-6"J__
2'-1 1 j"
8" x 16"
Knockouts V 2 Ea. Side Wall
4 Total
1"0 Ground Rod
Knockouts
2 Total
6" 0 Sump
6" Diamond Plate Galv.
fic Cover
i" x 4'-0"
n Spot
acessed Lifting Pin
8" Overall Tx
[— 6" Concrete
�i 2" Frame
e
Optional
12" Riser
6" Riser
2 Ton Swiftlifts
4 Total
4'-0" 4'-8"
�>
PAGE 01/01
1/2"0 i-5000 Plastic Inserts
2 Ea. Side Wall
4 Total
16" x 16' Knockout
1 Ea. End Wall
2 Total
7/8"0 Pull Irons
2 Total
Approximate Weights
Base — 2200 Lbs
6" Riser — 400 Lbs
12" Riser — 800 Lbs
SCALE:3/8" = 1'-0"
Overall Outside Dimensions
3'-2"W x 4'-8"L x 43 1/2"H
Overall Inside Dimensions
2'-6 W x 4'-0"L x 36"H
�Oldcastle
EDISON 26436FPB
2'-6" x V-0" x 3'-0"
Precast'
UTlLIIYYIULT'
Sou&mACatlror"la
ray ono, San Oiuj% Sens¢ Paula
Phnrg: NO.4263MO. Fax: 90&428-3737
Flatwall Pull Box
Edison UGS# 220.1
Copyright 0 20D7orftrebr'Pmcw,wc
ME MME 070UEP26436FED.DWG
ISSUE DATE: June 2004
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