06-0022 (RPL)a
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00000022
52705 AVENIDA OBREGON
773-284-023-10 -000000-
POOL - RESIDENTIAL
COVE RESIDENTIAL
40000
Tiht 4 4 Q"
Architect or Engineer
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm under penalty of perjury that I a licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business an rofessionals Code, and my License is in full force and effect.
License Classss:C53 / License No.: 818538
Contraer!Sr�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and rofessions 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 Contrac'tor's State
License Law (Chapte"r 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
11lbany applicant fora 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 town 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. , 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 permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
BERGER TERJE
52-705 AVENIDA OBREGON
LA QUINTA, CA 92253
Contractor:
HIRE STANDARDS POOL CONSTR
P.O. BOX 4713
PALM DESERT, CA 92261
(760)578-4041
Lic. No.: 818538
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/17/06
----------------------------------------------—
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
IX 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 STATE FUND Policy Number 00295202006
I certify that, in the performartecome
ork for which this permit is issued, I shall not employ any
person in any manner so subject to the workers' compensation laws of California,
and agree that, if I shouldject to the workers' compensation provisions of Section
3700 of the Labor ode, ith comply with those provisions.
Date: .o Applicant:
WARNING: FAILURE TO SECURE WOR RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,000). IN ADDITION T THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, I TEREST, 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 state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin construction, and hereby authorize representatives
of this
/coymyydto enter upon the above-mentioned prop y f r ins tion purposes.
Date: I 1 O Signature (Applicant or Agent):
Application Number . . . . . 06-00000022
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
343.00
Plan Check
Fee
222.95
Issue Date . . . .
Valuation
. . .
. 38268
Expiration Date . .
7/16/06
Qty Unit Charge
Per
Extension
BASE FEE
252.00
14.00 6.5000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
91.00
Permit . . .
MECH POOL
_ Additional desc . .
Permit Fee . . . .
26.00
Plan Check
Fee
6.50
Issue Date . . . .
Valuation
0
Expiration Date . .
7/16/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
----------------------------------------------------------------------------
EA MECH FURNACE
>100K
11.00
Permit . . .
ELEC POOL PERMIT -RES
Additional desc . .
Permit Fee . . . .
45.00
Plan Check
Fee
11.25
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date . .
7/16/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
----------------------------------------------------------------------------
EA ELEC PRIVATE
SWIMMING
POOL
30.00
Permit . . .
PLUMBING
Additional desc . .
Permit Fee . . . .
33.00
Plan Check
Fee
8.25
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date . .
7/16/06
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
1-4 OUTLETS
3.00
Permit . . . . . .
WALL/FENCE PERMIT
LQPERMIT
Application Number . . . . . 06-00000022
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 41.00 Plan Check
Fee..
.00
Issue Date . . . . Valuation
. . .
. 1732
Expiration Date . . 7/16/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
13.00 2.0000 HND BLDG 501-2,000'
26.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL & SPA ONLY. 80 L.F. 5' GARDEN
WALL, CITY STANDARD. ALARMS/BARRIERS
SHALL BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION.
Fee summary Charged Paid Credited
---------------------------
Due
--------------------
Permit Fee Total 488.00 .00
----------
.00
488.00
Plan Check Total 248.95 .00
.00
248.95
Grand Total 736.95 .00
.00
736.95
LQPERMIT
Bin #
City of La nuinta
1 �C
Building eL Safety Division
P.O. Box. 1504, 78-495 Calle Tampico
La Quinta,.CA 92253 -.(760) 777-.7012
Building Permit. Application .and Tracking Sheet
Permit #
O� O O��
Project Address: �2 7D j 09A o0lq.
Owner's Name:
A. P. Number:
Address: 5Z705'�. �(JG ffrf��j. oenvc-aril
Legal Description:
Contractor: T(i2E S7 D. �� 061— C'avSr
City, .ST, Zip: LA QVI M-4
Telephoner V '
Address: -7429,0
Project Description:
City, ST, Zip: Pte+ hJ155S t
Telephone: 3�(I 3?�.
City Lie. #:
ZJb ✓ ,'f (�f
State Lie. #
Arch., Engr., Designer:
Address:
0
City, ST, Zip:
tv
Telephone:
Construction Type: Occupancy:
State Lie. #:
Project.type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: �%�1% . L ((?Z -F—
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person: —j(op 3q1 ? -,)� 77
Estimated Value of.Project: (, 6.0a oo lk—
APPLICANT: DO NOT .WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted.Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2q' 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 correctionsrssueDeveloper
Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
1
I
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i I - -, - '' - -, - ,
APPROVED BY COMMUNITY DEVELOPMENT DEPARRTMMENI
®Y^ \ DATE
EXHIBIT
Wt Nd.
CIT`t OI" LA QUI►STA
BUILDING & SAFETY DEPT.
APPROVED
FORI{�CONSTRUC
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DATE �tIy BY
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