06-0735 (RPL) Change of ContractorP.O. BOX 1504
78L L 495 CALLE TAMPICO
�A QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant: .
�0160
06-00000735 1
52685 CABO SAN LUCAS
767-200-011-31 -318741-
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
22000
Tiiit 4 4.0"
Architect or Engineer:
� A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MILLER
52-685 CABO SAN LUCAS
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)39879222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Date: 4/04/07
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LICNTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I rider provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one. of the following declarations:
JPfe
Section 7000) of Division 3 of the Busin aio als 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 CI s: 8 C27 C29 License No.: 656128
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
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issued.
Date: Contractor:
I have and will maintain workers' compensation insurance, as required by Section 3700 of.the Labor
— > I
_
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy numbe are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for tote
Carrier SEA 3RIGHT P mber BB1070510
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 h work which this permit is issued, I 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 manner as to be e,subje t 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 ou beco a ject the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Lab Cod I she forth it comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
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any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:
Date: !J Applicant
1 _ 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: FAILURE TO SECURERKERS' COMPOWZZTIQWCOVERAGE 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 CRI AL 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 1$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
I_ 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,
1 _ 1 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
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
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 nd void if work is not commenced
within 180 days from date of issuance of such -permit, or ce sation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the ab a informatio is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin c nstru tion, a d hereby authorize representatives
of this courly to enter upon the above-mentioned property, or
Date:
(Applicant or Agent):
Application Number .
. . . . 06-00000735
Permit' . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
225.00 Plan Check Fee
146.25
Issue Date . . . .
2/24/06 Valuation . . .
. 22000
Expiration Date
8/23/06
Qty Unit Charge
Per.
Extension
BASE FEE
45.00
20.00 9.0000
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THOU BLDG 2,001-25,000
.180.00
Permit . . .
MECH POOL
Additional desc . .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
2/24/06 Valuation
0
Expiration Date
8/23/06
Qty Unit Charge
r
Per
Extension
BASE FEE
15.00
1.00 11.0000
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EA MECH FURNACE >100K
11.00
Permit . . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
2/24/06 Valuation . . .
. 0
Expiration Date
8/23%06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
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EA ELEC PRIVATE SWIMMING POOL
30.00
Permit '. . .
PLUMBING
Additional desc . .
Permit Fee . . . .
33.00 Plan Check Fee
8.25
Issue Date . . . .
2/24/06 Valuation . . .
. 0
Expiration Date
8/23/06
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 174 OUTLETS
3.00
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Special Notes and Comments
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
LQPERMIT
Application Number . . . . . 06-00000735
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Special Notes and Comments
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
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Other Fees . . . . . . . •CHANGE OF CONTRACTOR 4.50
REPLACEMENT INSP CARD 15.00
Fee summary Charged Paid Credited Due
Permit Fee Total 329.00 329.00 .00 .00
Plan Check Total 172.25 172.25 .00 .00
Other Fee'Total 19.50 .00 .00 19.50
Grand Total 520.75 501.25 .00 19.50
LQPERAIIT