11-0906 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA:QUINTA, CALIFORNIA 92253
Application Number: 11-00000906
Property Address: 51905 AVENIDA OBREGON
APN: 773-163-019-7 -000000-
Application description: POOL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 18000
.Applicant:
c&t�v 4.4 Q�«tw
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner -
ANDERSON
51905 AVENIDA
TA, CA
OBREGON
92253
POOLS- & SPAS
OTH, AVENUE
DUNES, CA 92203,
5-8302
.: 634338
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/25/11
-
----------------------------
- LICENSED CONTRACTOR'SDECLARATION
_WORKER'S COMPENSATION DECLARATION
. Thereby affirm under penalty of perjury that I amlic sed under provisions of Chapter 9 (commencing with
-
'I. hereby affirm under penalty of perjury one of the following declarations:o •- -. _
Section 7000) of. Division 3 of the Business and rofe i aIII License -.is in full forceandeffect.
I have and will maintain a certificate of consent to self -insure for workers'. compensation, as.provided.
_�my
License Class: C10 C53 - tens No . 63433 8 .
_
for by Section 3700. of the Labor Code, for the performance of the work for which this permit is
c
�COn_tract0 . -
issued.
_ I have. and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
.r
Code,. for the performance bf the work for which this permit is issued. My workers' compensation
' OWNER -BUILDER DEC RATION
- insurance carrier and policy number are: '
I hereby affirm under penalty of perjury that I am exempt from the Cont actor's Statetiicense Law for the
Carrier EVEREST NAT!i* Policy Number 7600006331101
following reason (Sec. 7031 .5, Business and Professions Code: Any cit or county thatrequires a.p&rnit to
_ I certify that, in the performance of the work for which this permit is issued,.) shall not employ any
construct, alter, improve, demolish, or, repair any structure, prior to its issu ce, also requires the,applicantfor the
'subject to a workers;compensation,laws of California, '
..,
person in any manner,so as to tikebb
. permit to file a'�signed statement that he or she.is;licensed.pursuant to.the provisions of the:Contractor's State
and..agree that, da:sfiouldbe o. aworkers"compensation provisions ofSection
License Law (Cfi'pter9�(commencing:with Sectio n. 70001ofDivisioni3 of the Business and Professions Code) or
..
) 3700 of the Labor Code, hal rth o I with'tho ovrsion
that he orshe is ekempt therefrom and the basisfor [healleged exemption. Any violation of. Section 7031':5 by
/_.Y _
any applicant for a permit subjects the applicant; to a civil -penalty of not"more than five. hundred dollars (S500).:
1 _ 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,
andmho.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 salea--
(_ 1 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•iniproves thereon; and who contracts for the projects with atontractor(s) licensed
pursuant to the Contractors' State License Law.). -
(_ 1 I am exempt under Sec. , BAP.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 permii.is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
N. RA E I NLAWFUL AND SHALL
. WARNING:. FAILURE TO SECURE WORKERS'. COMPENSATIO CO G S U
SUBJECT AN EMPLOYER TO.CRIMINAUPENALTIES AND CIVIL FINE UPTO ONE -HUNDRED THOUSAND
DOLLARS ($100;00.0);' IN ADDITION 70 THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR•IN
SECTION 3706OF THE LABOR;CODE, INTEREST, AND ATTORNEY'S,FEES.
- APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby.rnade to the Director -of Building and Safety for a permit subject to the
conditions and restrictions set forth.on this application.
1. Each •persomupon•Whose behalf this application is made; each person at Whose request and for
whose benefitwork 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. Ariy permit issued as a result of this application becomes null and void if work is not commenced.
within 180*ys. 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 information is correct..( agree to comply with,all
city and county ordinances and -state laws relating to building constructio and h y a J horize representatives
of this,county to enter upon the above-mentioned property for inspeetlprjur 64's- _ 11
Application Number . . . . 11-00000906
Permit . . . MECH POOL
Additional desc ...
Permit Fee 26.00 Plan Check Fee
6.50
Issue Date . . . . Valuation
0
Expiration Date 2/21/12
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 . . . . 189.00 Plan Check Fee
122.85
Issue Date. Valuation
18000
Expiration Date 2/21/12
Qty Unit'Charge Per
Extension
- BASE FEE.
45:00 '
16.00 9.0000 THOU BLDG 2,001-25,000
144.00
`Permit ELEC POOL PERMIT -RES
i -� Additional desc
Permit Fee 1 45.00 Plan Check ".Fee
11.-25
Issue Date Valuation
.0
Expiration Date 2/21/12
— .. Qty Unit Charge Per.
Extension
BASE.. -FEE
15.00
1.`00 30.0000 EA ELEC PRIVATE SWIMMING -POOL
30.00.E
'Permit . . .PLUMBING.
Additional desc .
Permit' Fee _ 33.00 Plan Check. Fee
8.25
Issue. Date Valuation'
01
.Expration,Date 2/21/12
Qty" Unit.Charge: .Per
Extension
BASE FEE
15.00:
2.00 6.0000 EA PLB FIXTURE
12.00
1.00 .. 3.00,Q0 EA PLB,WATER INST/ALT/REP
3.'00
1.00 3..0000 EA •-.PLB GAS PIPE 1-4 .OUTLETS
.F -.
3.'00
'
Special Notes and Comments
POOL/SPA. ALARMS%BARRIERS SHALL BE IN
LQPERMIT
LQPERMIT
Application Number . . . . . 11-00000906
-------------------------------------------------------------
Special Notes and Comments
-
--------------
1PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
2010
CODES.
------------------------------------------------
Other Fees . . . .. . . . BLDG
STDS ADMIN_(SB1473)
1.00
Fee summary Charged
Paid .-.Credited
Due
Permit -Fee Total 293.00
.00
,00
293.00
Plan Check Total 148.85
.00
.00
148.85
Other Fee Total 1.00
.00
.00.
1.00
Grand Total 442.85
.00
.00
442.85
LQPERMIT
0
•
0
On/Off switch 4
Timer Controls
(outside of horn
/ NA�ME: MITI H AN'Di EIISON
ADDIRESS:51-965 AVE
OBIII3r1)N
On/Off Valve
for Misters CIMLA QUINTA, CA 92253
Umbrella
Inserts
(2)^
.e.
t
0 3 w/dd
8 §
0 Sew/d.�
3 Steps
iri
(each 9" high)
c
Deep
owl
18" flower bed
' CIS ,SOF UI T
Spa has S ack StoAPTYR O e/ E D
FOR CONSTRUCTION
DAT Z
18" flower bed sic
OFFXE
(760)345-830 _
Lic CIO C53 #634338
NAME: ANDERSON RESIDENCE
ADDRESS: 51-905 AVE OBR.EGON
CITY: LA�UINTA, CA 92253
Bin #
City of La Quinta
Building Bt.:Safery Division
P.O.. Box 1504, 78=495 Calle Tampico
La Quinti, CA 92253 =' (760)77, 7-7012
BUi10�0g-Permit Application, and�Tracking Sheet
Permic #
`
Project Address:.
�. .� 7 V � 10L b ,v.
Owner's'Name:
A. P. Number:
:
Address' 7
Legal Description: '
City,.ST, Zip:4u S
Contractor: (
o 0 ` S
_O
Telephone:
.Address: _ G L� �u
Project Description:
City, ST, Zip: r -, ,.0 , -3
C) ZS
•hv'y {:
Telephone:? 3VJ 2- "'>,
State Lic. #: �� 3,.. city Lic, #:
Arch., Engr., Designer:
4'
Address:
City, ST, Zip:
Telephone: . !..�
i. "\.N%,:`{��•�H '9'..:
State Lic. #; + "' 'f�
Name of Contact Person: I f -
Construction T an
Type: occupancy:
'• Project type circle one New Add'n Alter Repair Demo
S9'' Ft # Stories: # Units:
Telephone # of Contact Person: 0-� --7j Q _
Estimated'Value of Project: �� 06O
APPLICANT:, DO NOT,WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING I PERMTI FEES
Plan Sets
PIan.Check anbmitted�
Item Amount
Structural Cala.
. Reviewed, ready for corrections
Plan Cheek Deposit
Truss Calm
Called Contact Person
F Plan Check Balance.
Title 24 Gla
Plans picked up
Construction
Flood plain plan
Plan's resubmitted
Mechanical
Grading pian
2"' Review,'ready for correcGodsJissue
Electrical
Subcontactor List
Called Contact Person .
Plumbing
Grant Deed
Plans picked up
SMI.
J110 A..Approval
Plans resubmitted
Grading
IN HOUSE:=
'"' Review, ready for correction issue -
` Developer Impact Fee
Planning Approval
.Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees