05-5535 (CP)P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
05-00005535
80440 -HIDEAWAY CLUB CT
772-410'-998-30 -32453 -
POOL - COMMERCIAL
LOW DENSITY RESIDENTIAL
3000
Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
1.
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with '
Section Pool of Division 3 of the Business d Professionals Code, and my License is in full force and effect.
Lice Class: C8 C27 C2,9 License No.: 656128
ate:/Z �7m r�i ntractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury thaA 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 thaYhe 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.).
( 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
Owner:
ND LA QUINTA PARTNERS
375 N FRONT ST STE 200
COLUMBUS, OH 43215
Contractor:
CALIFORNIA POOLS & SPAS
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/22/05
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
1�A issued.
IN have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
�t Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier SEABRIGHT INS ' Policy Number BB1050510
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 Iaws.of California,
and agree that, if 1should be me subject to the workers' compensation provisions of Section
'Z�'73700 of the Labor Cod rthwith comply with those provisions.
ate: G ` +�'�p ant:
WARNING: FAIL EE TRE WORKER' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENA TIES 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 statethat the ove information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildi construction, and hereby authorize representatives
of this my to enter u on th above-mentioned property pection purposes.
Sig cure (Applicant or Agent):
Application Number '
. . . . 05-00005535
Permit . . . . . .
BUILDING PERMIT
Additional deoo . .
Permit Fee . . . .
54.00 Plan Check
Pee .
. 35.10
zoove Date . . . .
Valuation
. . .
. 3000
Expiration Date . .
6/20/06
Qty Unit Charge.
Per
Extension
oaoo FEE-.
45.00
1.00 9'0000
----------------------------------------------
— — —
THOU BLDG %'OOl-2s,OOO
— ~--------------
'
9z.00—
Permit . . . . . . .
ELEC-MISCELLANEOUS
Additional deoc . .
Permit Fee . . . .
18.00 Plan Check
Fee .
. 4.50
` Issue Date ' . . .
Valuation
. . .
. O
Expiration Date . .
6/20/06 '
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 3.0000
---------------------------------------------------------------
�
EA EzaaC gwa APP ^~1
3.00
Pezmit ... . . . .
eLlonBIums `
Additional deoo
Permit Fee . .
31.00 Plan Check
Fee '
. 5.25
Issue Date
Valuation
. ` '
. O
Expiration Date . .
6/20/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 6'0000
EA eLB FIXTURE
6.00
_________________________________________________________
i l Notes and Comments .
vmxrER FEATURE "B".sr
LOWER COURTYARD,
PER APPROVED PLANS
Fee summary Charged
Paid Credited
Due.
----------------- ----------
Permit Fee Total
--- ------ ----------
93.00 .00
----------
.00
93.00
Plan Check Total
44.85 'OV
.oO
44'85 �
Grand Total
137.85 .Oo
.OV
137'85
LQPERMIT