10-0391 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 '
Application Number:
T.0_0'0'00'0391
Property Address:
<5 2,976 AVEN� ID`A OBREGON
APN:
773-315-012-12
Application description: description:
POOL - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
20000
.BUILDING & SAFETY DEPARTMENT
BUILDING;, PERMIT
Owner:
CRUZ ROBERTO
52980 AVENIDA OBREGON
LA QUINTA, CA 92253
Coritractor:
Applicant: Architect or Engineer:: m A,& R -COMPLETE POOL •SERVI
38405 RANCHO LOS COYOTES
INDIO,.CA 92201
(760)272-7349.
Lic.'NO.: 841981
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153 `
l'J
Date: 5/04/10
MAY 0 6 2010
-------------------------------
LICENSED CONTRACTOR'S DECLARATION -
WORKER'S COMPENSATION DECLARATION
. Ihereby affirm underpenalty of perjury that 1 am licensed and provisions of.Chapter 9 (commencing with,.
I hereby affirm underpenalty of perjury one of the following declarations:
' 'Section.7000) of Division 3 of a Busine s'andProf -siona .Code,"and,myLicense:is in full force and effect.
" _ "1 have and will maintain -a certificate of consent°to self -insure for workers' compensation, as provided
license Class: C53 icense iZ:. 841981 -
- - foFby Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate Contrac .. - -
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
' .4:.. ; .
-- Code,�for the. performance of the work for which this permivis issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
1 hereby affirm under penalty of perjury that I arh exempt,from-the Contractor's State License Law for the
Carrier E} 'MPT' '-.: _ Policy, Number EXEMPT
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 the work for which this permit is issued, l 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 rimanner-sous to become subject to the workers' compensation laws of California,
permit to file a signed statement thatheor she is licensed -pursuant to the provisions of the Contractor's State
and agree that, if I, shouldbecome subject to 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. theL or Co s aII'forthwith 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
any' applicant. for a. permit subjects the applicant to a civilpenalty of not more than five hundred dollars ($500).:-
e: W '�-V A t: "
(_) I, as owner of.the property,or my employees: with wages as,their sole compensation, will do the work, and
the structure isnotintendedor offered for sale (Sec..7044, Business and Professions Code: The' -.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors'. State "License Law does not apply to an,owner ofproperty Who builds or improves thereon,
SUBJECT>AN EMPLOYER TO CRIMINAL PENALTIES AND CIVILFINES UP TO ONE HUNDRED THOUSAND
and who does tfie.work himself or herself.through'his or her'own employees, provided that the ` -
DOLLARS'($.100,000)• IN -ADDITION TO THE COST. OF'COMPENSATION, DAMAGES.ASPROVIDED FOR IN
. improvements are -not intended or offeied for sale.If, however, the building or improvement.is sold within
SECTION 3706 OF, THEIABOR 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
'
impr'ovelfor the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT'
(_) 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 projecti. with a contractors) 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 peimit issued as a result of this application,
I—) I am exempt under Sec. BAP.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 employeesforany 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 relatin o buildin onstruction, d hereby authorize representatives
ter uponthe above -mentions property r inspection p poses.
Lender's Name:Sign
�Dafe.re (Applicant or Age
Lender's Address:
LQPERMIT
Application Number . . . . . 10-00000391
Permit . . .
ELEC POOL PERMIT -RES
Additional desc . .
Permit Fee . . . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
10/31/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
----------------------------------------------------------------------------
EA ELEC PRIVATE SWIMMING POOL
30.00
Permit . . .
BLDG POOL PERMIT
.Additional desc . .
Permit Fee . . . .
207.00 Plan Check Fee
134.55
Issue Date . . . .
Valuation . . .
. 20000
Expiration Date
10/31/10
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2;001-25,000
162.00
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
27.00 Plan Check Fee
6.75
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
10/31/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00 _
1.00 6.0000
EA PLB FIXTURE
6.00
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
7 ---------------------------------------------------------------------
Special Notes and Comments
POOL ONLY. ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER
INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. 2007
CODES.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
--------------------
Due
---------------------------
Permit Fee Total
----------
279.00 .00 .00
279.00
Plan Check Total
152.55 .00 .00
152.55
Other Fee Total
1.00 .00 .00
1.00
LQPERMIT
Application Number . . . . . 10-00000391
Grand Total 432.55 .00 .00 432.55
LQPERMIT
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ROBERT&. LETTY CRUZ
52980 AVENIDA.O,BREGON
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Bin #
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Qty of La Quinta
Building Bt,Safet Division
P.O. Box 1504, 78495"Calk Tampico
La Quinta, CA`92253-.(760j 777-7012
Building Permit ApplidtionandTratking Sheet
Permit #
Project Address: 011q?o VeAjld.P, D61tC60AJ
Owner's Na*. k6bera Ce
A. P. Number:
Address: 5� 9 �(O j4y' b,+-,eO J
Legal Description:
ip W_YIfiC. O IS
City, ST, Zip: ( n,lp ga•.,.���.�;1.x.3 k<•
?Contractor: r:. i<r•Sa.A4�r;;..
Telephone: p- _7
10644q-044-
Project Description:
Address:
Address:t5v)c 3
City, ST, Zip: L . 04.l,i Yui 14 9aa 4 %POb
I 0 itl �y I ' I D
Telephone: T00-4-72,73 : ` }cr"
n ::r. • <>. ':s..c::: y :. ssr
1 i'�/1Q! _ (tit V1Af AJ A-
State Lic. # : W1 Owl city lie. #;. a '41 S
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:ys.�.yx`4r
State Lic. #
.r , 4,: v..
Win.<::..:::•rv;v�..i.Gur/ .. +.;9Y•r^ ;a
'Construction Type: NZ i,v Occupancy:
ro ect a circle'one New . Add'n Alter Repair Demo
Name of Contact Person: R O R LD e Z
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 1 0 _. of = 15!P
Esiirimated Value of Project: 901 000
APPLICANT: DO, NOT,WRITE.BELOW THIS LINE
N
Submittal
Re4'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted.
Item
Amount
Structural Cales.
'Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21" Review, ready fon 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:-
''a Review, ready for correctionstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P,P,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CITY OF LA QUINTA SUB -CONTRACTOR LIST
J09 ADDRESS V l V DlU PERMIT NUMBER OWNER�CZ BUILDER
This form shall be posted on the,job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to worl
on this job.- Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result 'in a stoppage of work and/or the voidanc(
of building permit. For each applicable trade, all information requested below.must be com leted by. applicant. "On file" is not an acceptable response:
Trade / Classification
., ::- ConVactor� - .`::: =-::
..:..... .:.. .
,....;,.:�...:.:....:.. frac or s Lket►se.. ��.> .::.:. ��::�:.;;.
.....,.::..:::..:.::.:. Stat�:Con
:.: .-:.:.�_< �:.WPtker�'.. -.
Company Name
Classification
License Number
Exp. Date.
Carrier Name
Policy Number.
Exp. Date
license Number
Exp, Date
(e.g. A, B, C-8)
(xxxxxx)
lxx/xxlxx)
(e.g. State Fund, CalComp)
lFormat Varies)
lxx/xx/xx)
(xxxx)
lxxlicx/xx)
\ EARTHWORK (C-121 ....
0
� � t�o�-
L�'-�
S�+Iq
�-� is
A///4
J/4//_5
-
CONCRETE (C-8) --
I'U..I; .. CULAJ141E
&VP
74ri7N3
IZ-3I-11
Smrz
655 3-7a
/.-Z(o /I
wa5�2(p..
'FRAMING.:(C-51
STRUCT STEEL 1-151) ,
NO, I I•e qC ua1. 1-C,
IP X743
I2-3141
STMZ- T.fsc tamJCA
DSS:H3-7. ;LI
- -rr
/a�5a
ro -3i-i o
MASONRY (C•291
64—
'PLUMBING (C 3611,C17
:....
4e CO rvt I �jt. �oo I s
- 5, .
y I
-30 7).b
-.31 -i
LATH 'PLASTER {C.35)
vkW&L4 &yU,nj(4'G
- -DO cp
-193
I12 -31 -II
Si►9-�,. Tn]SLn.vr+-nJc,F-
` , d55L4.37e):
DRYWALL IC -9) .
HVAC ie=20i
6 ELECTRICAL (C=10)
_ Z
-J`
�/ I ` - i
7-p -�o
�%-
NG-
SHEET:METAL. (1=431...
•: ELO :RING �C`�:T51.:....`:.:>
-
- :
'�,
a
GLAZING IC
h
JNSULAT1001C-2) . - .:
A.
SEWAGE DISP (C-42)'
PAINTING (C=33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C=27) ?
0�L/.PO0'L_(C-53) I
UA-lzr, 1 &Iurvt+u7—
7)b(.P
3-19.
1-ala"II