14-0476 (RPL)P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 14-00000476
Property Address: 80320 RIVIERA
APN: 762-130-014--
Application
62-130-014 Application description: POOL - RESIDENTIAL
Property Zoning: LOW-DENSITY RESIDENTIAL
Application valuation: 55000
Apnt:. /��✓T/
plic6� A
X
Architect or� r:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LIC SED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjur a lice sed under provis
ions of Chapter 9 (commencing with
eA6siness J�,of M.naions of Chapter 9 (commencing with
7000) of Division 3 of the siness d ,off M.nals Code, and my License is in full force and effect.
License las j C27� C53 License No.:. 964474
'OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that am exempt from the Contractor's State License Law for the
following reason (Sec. 7031. , Business an Professions Code: Any city or county that requires a permit to
construct, alter, improve, de olish, or repa' any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statem t that he or he is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (com ncing wit Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefr and th basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subject the ap licant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 1, as owner of the property, 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.)..
(_ 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 improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) 1 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/28/14
Owner:
JAN CHRISTIAN
80320 RIVIERA D
LA QUINTA, CA 92253
MAY0 201.4Contractor:
DESERT OUTDOORS INC CITY OF LA QUINTA
78065 MAIN ST STE # OS FIN4NCEOEP?
LA QUINTA, CA .92253
(760)399-9600
LiC. No.: 964474
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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
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 AMTRUST' INS CO P i Number WWC3072369
_ I certify that, in the performance of he rk fo hich this permit is issued, I shall not employ any
person in any manner so as to b ome u ' c to the workers' compensation laws of California,
and agree that, if I should beco sub' to he workers' compensation provisions of Section
3700 of the Labor Code, I shall orth ' h mply with those provisions.' .
Date�`l Applicant:
WARNING: FAILURE TO SEC E WORKERS' 0 PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO RIMINAL PENA T S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND -
DOLLARS ($100,000). IN AD ITION TO THE OST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LAB) CODE, INTER ST, AND ATTORNEY'S FEES.
\ APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby 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 becom II and void if work is not commenced
within 180 days from date of issuance of such permi or cessation of work for 180 days will subject
permit to cancellation.
I.certify that I have read this application and state that the i fo atio ,correct. I agree to comply with all
city and county ordinances and state laws relating to ing can coon, d hereby authorize representatives
of thi>P&Up<topmSr upon the above-mentioned p perty for in a ion S.
I \
Date Signature (Applicant or Ager} ):
Application Number . . . . . 14-00000476
Permit . . . POOL 2013
Additional desc .
Permit Fee . . . . 178.75 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 10/25/14
Qty Unit Charge Per
Extension
1.00 178.7500 EA MISC POOL/SPA
----------------------------------------------------------------------------
178.75
Permit ELECTRICAL 2013
Additional desc BBQ ONLY
Permit Fee 23.83 Plan Check Fee
.00
Issue Date Valuation . . .
0
Expiration Date 10/25/14
Qty Unit Charge Per
Extension
1.00 23.8300 LS ELEC DEVICES, FIRST 20
----------------------------------------------------------------------------
23.83
Permit . . . WALL/FENCE PERMIT 2013
Additional desc .
Permit Fee . . . . -47.-19 Plan Check Fee
.00
Issue.Date. Valuation .
. 55000
Expiration Date 10/25/14
Qty Unit Charge Per -
Extension
1.00• 47.1900 LS MISC WALL, FIRST 100 LF
47.19
--------------------------------------------------------------
Special Notes and Comments
--------------
POOL, SPA, BBQ AND 25LF OF 6' HIGH BLOCK
WALL AT REAR YARD [DENISE POELTLER
ENGINEERING] .THIS PERMIT DOES NOT ti•
INCLUDE EQUIPMENT ENCLOSURE OR WATER
FEATURES. ALARMS AND BARRIERS REQUIRED
TO BE INSTALLED AT PRE -PLASTER
INSPECTION. 2013 CALIFORNIA BUILDING
CODE.
April 28, 2014 4:40:54 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
3.00
PLAN CHECK, ELECTRICAL.
23.83
PLAN CHECK, POOL
97.24
PLAN CHECK, WALLS
60.06
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
LQPERMIT
Application Number
. . .
14-00000476
Permit Fee Total
249.77
.00
.00
249.77
Plan Check Total
.00
.00
.00
.00
Other Fee Total
184.13
.00
.00
184.13
Grand Total
433.90
.00
.00
433.90
LQPERMIT
Bin #
City of La Quinta
Building 8F Safety Division
P.O Box 1504,79-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1 " y�.
Project Address: $O32Q
Owner's Name. ? a S
A. P. Number.
Address: 030-32.0 law
Legal Description:
City, ST, Zip: LIN G t o —TIev
Contractor:
Telephone: '
Address: ?eo(DS 45r ISM 2PI5
Project Description:
City, ST, Zip: LA QuCA
45E ,J fccL s r5 A
Telephone , 3 40 3 s> 3 1
lA C
State Lic. # : City Lia 9--
Arch, Engr., Designer. -
Address:
City, ST, Zip:
Telephone:
State Lia #:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Ft.: T# stories: # Uaits:
Name of Contact Person:Sq.
Telephone # of Contact Person:. --7-2--59
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
Recd
TRACMG PERMIT FEES
Plan SetsPlan
Cheek submitted ' Item Amount
Structural Cates.
Reviewed, ready for corrections Plan Check Deposit
Trus Cates•
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Giading plan
2" Review, ready for correction sfissue Electrical
SubcontactorList
Called Contact Person Plumbing
Grant Deed
Pians picked up SAU
H.O.A. Approval
Plans resubmitted Grading
IN ROUSE:-
7n° Review; ready for correetio eveloper Impact Fee
Planning Approval
Called Contact Person A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees S� •qi
I yr,
1%.