09-0603 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: Owner:
603 Owner:
Property Address: 51884 AVENIDA OBREGON STEVE ,SAFT .
APN: 773-1`_64-025-8 -000000- 51884 AVENIDA
Application description:: POOL - RESIDENTIAL, LA QUINTA, CA
Property Zoning COVE RESIDENTIAL"
Application valuation: 20000
Applicant:
Architect or Engineer:
OBREG(
92253
Contractor:
A.1 POOL CONCEPT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/09/09
P.O. BOX- 623 ..9�. y wy •,.
LA,QUINTA, CA 92253
(760) 771-9822
Lic. No:: 746662
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LICENSED -CONTRACTOR'S DECLARATION. WORKER'S _COMPENSATION,DECLARATION:r'
I
hereby affirm under penalty of. er'ur that Lam licensed rovisions of Cha ter 9 (commencing with I hereby affirm under: enalt of perjury one of followin declarations:
Y P Y P 1 y'. P p ( 9 Y ,P Y P I Y 9
•Section 70001 of Division 3 of theBusinessrandiProfessionals Code, and m ense is in fulLforce arideffect. _ I have and will.maintaima certificateof:corisent to self -insure for workers compensation, as provided
License Class: C;2 C53 'cense: No.: 662 - - for by,Se_ ctiori 3700.of the Labor Code -for the perforniance of the work for which this permit is
F� issued.
ate. tra ' . _ I have andwill 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
. OWNEWALI'lLDER: DECLARATION -"" 7 ,. insurance carrier arid -policy number are:
I hereby affirm under penalty of perjury that Fam ex6mpvfrom the Contractor's State License Law for the Carrie, STATE FUND Policy Number 1576693: 2008
following reason.lSec. 7031 i5,.8usiness and Professions Code: Any city or county that requuesya;permit to _ 1 certify that, in.tK6 performance of the work -for which this permit is.rssued,a 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 mannerso as,to become subject to the workers!,. compensation laws of Cahfoirija,
permit to file a signed statement that he. orshe.is licensed pursuant. to the provisions of.the Contractors S6te - and`agiee that, if,I should"becom "bje o the workers', comp -"anon provisions. of Section -
License Law'(Chapter'9_Icomrnencing with Section 70001 of Division 3 of the'Business'and Professions Cotle)•or _ 3700 ofth Lab shall' ti`co nply with those' o "ions.' -
that he:ovshe is exempftiherefrom and'the basis for the alleged exemption.. Any wolafion of Section 7031.5 by -
any'applicanT.for a.permrt subjects the applicant.to a civil penalty of not more thanfive;hundred dollars ($500).: ate _� pplrc t_ '
( ) I;: as owner of•the property, or my.employees with wages; as their sole compensat'on willAo the work, and' _
the. structure is not intended or offered for sale.(Sec. 1044: Bu"siness-and Professions"C'ode The' _ WARNING: FAIL RENO SECURE.WORKERS'-COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL;_.
Comractors:sState License Law;does not apply to an owner of property who builds or improves thereon, SUBJECT AN.EMPLOYER TO CRIMINAL 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 ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES'AS PAOVIDED:FOR IN'
improvements are n66htended or offered for sale. If, -however_, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'STEES.
one year -of completion, tiie owner -builder will have the burden of proving that he or she -'did not buildor
improve for the purpose of sale.). - APPLICANT ACKNOWLEDGEMENT - -
(_) I, 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(sl 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 isperformedunder or -pursuant to any permit issued as a result of this application,
.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
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.
Date: Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building c ae ction, and.hereby au a "ze representatives
nI� of thi aunty o enter upon the above -me ne ope D pact n purposes.
Lender's Name: 1\ YA t yC' nnaatture (App
Lender's Address:
LQPERMIT
Application Number . . . . . 09-00000603
Permit . . . . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 207.00 Plan Check Fee 134.55
Issue Date . . . . Valuation . . . . 20000
Expiration Date 12/06/09
Qty Unit Charge Per Extension
BASE FEE 45.00
.18.00 9.0000 THOU BLDG 2,001-25,000 162.00
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Permit . . . MECH POOL
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . 0
Expiration Date 12/06/09
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE >100K 11.00
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Permit . . . ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 12/06/09
Qty Unit Charge .Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30:00
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Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 33.00 Plan Check Fee 8.25
Issue Date . . . . Valuation . . . . 0
Expiration Date 12/06/09
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
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Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
LQPERMIT
Application Number . . . . . 09-00000603
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Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. 2007
CODES.
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Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged Paid Credited Due
Permit Fee Total 311.00 .00 .00 311.00
Plan Check Total 160.55 .00 .00 160.55
Other Fee Total 1.00 .00 .00 1.00
Grand Total 472.55 .00 .00 472.55
LQPERMIT
Bin #
Cit Of L ; C1fC1
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" Building;8r Way:Riufsforr'
P.O. Box 1504; 78495 Caffe'Tampfco
;, ... La,Qulnta, CA 92253. (760) 777-7012 .
Bu1ld1ng. Fern It Abp1icatjon and. Tracking Sheet
-
Permit #
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Project Address:�,r9' ��1 a
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Owner's Name:
A. P. Number:
Address:
Legal Description:City,
ST,^Zip:,
Contractor:
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Telephon / �'.��L
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Address: ����
Project Description:
City, ST, Zip: L,q-Gad nr�:
Telephone: , 5- �!.
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State Lic. # : f%�'''L
CityLic. #t'
Arch., Engr., Designer:.
Address:
City., ST, Zip:
Telephone:.
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. Construction Type:: Occupancy:
State Lic. #c
Project type (circle one): New . Add'n ,Alter Repair Demo'
Name of ContactPerson:` &V/,,- -
Telephone # of Contact Pe so 1,;,_ 14X
.Sq. Ft.: # S ries .�� #Units:
Estimated Value of Project;
APPLICANT ,DO NOT WRITE BELOWTHIS`61NE.
#
Submittal
Req'd
Recd
°`mTRACKIIVG.
PERMIT FEES
Plan Sets:
P[an Check submitted
Y
Item
Amount
Structural Calcs.
Reviewed, rea3y for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2a° 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:-
7rd Review,.ready for corrections/issue
Developer -Impact Fee
Planning Approval
Called.Contact-Person
Pub. Wks. Appr
Date.of permit issue
School Fees
Total Permit Fees
14'0