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13-0193 (RPL) IIIIIIIIIIIIIIIIIIIIIIIII 27 P.O. BOX 1504 IE Tdy VOICE(760) 777-7012 78-495 CALLE TAMPICO ✓ 4 Q" FAX(760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS(760) 777-7153 BUILDING PERMIT Date: 2/21/13 Application Number: 13-00000193 Owner: Property Address: 81399 ANDALUSIA KOSTY RESIDENCE APN: 764-620-029- - - 81399 ANDALUSIA DRIVE Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 29000 ^ l: p Contractor: U Applicant: Architect or Engineer: TESERRA FEB 2 2 2013 P:O. BOX 1280 COACHELLA, CA 92236 CITY OF IA QUINTA W� (760)398-9222 FINANCE DEPT. Lic. No. : 656128 U SED CONTRACTOR'S DECLARATION _ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that; licensed under provisions of Chapter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000 of ivision 3 of the Business a Professionals Code,and my License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided License Cla : 10,27,2 License No.: 656128 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is — issued. Date:Z ��� Contractor: 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 OWNER-BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EVEREST NATL IN Policy Number 7600006481131 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,I 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 manner so as to come subject to the workers'compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that,if I should bedo a 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 70 f the Labor Code,Ii rth stwith 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 civil penalty of not more than five hundred dollars($500).: Date: � Applicant: 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 WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL Contractors'State 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 PROVIDED FOR IN improvements are not intended or offered for sale. If,however,the building or improvement is sold within SECTION 3706 OF THE LABOR 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 improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT (_1 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 projects with a contractor(s)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 permit issued as a result of this application, (_) 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 4cstruction, ation is correct. 1 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 buildiand hereby authorize representatives of this count o er upon the above-mentioned propertyon purposes. Lender's Name: Date: 21 Signature(Applicant or Agent); Lender's Address: LQPERMIT Application Number . . . . . 13-00000193 Permit MECH POOL Additional desc .. . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 8/20/13 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 . . . . 278.00 Plan Check Fee 180.70 Issue Date . . . . Valuation . . . . 29000 Expiration Date 8/20/13 Qty Unit Charge Per Extension BASE FEE 252.00 4.00 6.5000 THOU BLDG 25,001-50,000 26.00 ---------------------------------------------------------------------------- Permit . . . ELEC POOL PERMIT-RES Additional desc . Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date . . . . Valuation . . 0 -Expiration Date 8/20/13 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 . . . . 27.00 Plan Check Fee 6.75 Issue Date . . . . Valuation 0 Expiration Date 8/20/13 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 ---------------------------------------------------------------------------- Special Notes and Comments NEW POOL & SPA BBQ, FIREPIT, AND 284 IN LQPERMIT • Application Number . . . . . 13-00000193 ---------------------------------------------------------------------------- Special Notes and Comments FT OF GAS LINE. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE-PLASTER INSPECTION. 2010 CALIFORNIA BUILDING CODE. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 2.00 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 376.00 .00 .00 376.00 Plan Check Total 205.20 .00 .00 205.20 Other Fee Total 2.00 .00 .00 2.00 Grand Total 583.20 .00 .00 583.20 LQPERMIT Blrr.# . . Ci0 La Quinta Bullding 8i Safety Dtdslon Permit# P.O.Box 1504,78-495 Calle Tamplco La.Qulnta,CA 92253 {760}777-7012 Building Permit Application and Tracking Sheet Project Address: g 3 71-- n j4l ownu's Name:. / f .! A.P.Number. Address: g)3,?y . nT3> i Legal Description: City,ST,Zip: - �wT� 2 3 Contractor. ,E2 Telephone: Address: 60 +� Project Description: City,ST,Zip �� 9223 t; L `i Telephoner 03�cq 22 2 tr ! j State Lic.#• 1 Z City Lic M i Arch.,Engr.,Designer. i Address: City.,ST,Zip: Telephone: Construction Type: . Occupancy: s I State Lic.#: Project type(cu+cle o e): New Ad d'n Alter Repair Demo Name of Contact Person: Sq.Ft.: #Stories: #Univ: j Telephone#of Contact Person: 3 p 0 /,q Estimated Value of Project: O O O APPLICANT: DO NOT WRITE BELOW THIS UNE . # Submittal Req'd Recd TRACMG PERMITFEES- PIs<n Sets plan Check submitted Item Amount Structural Calm Reviewed,ready for corrections Plan Check Deposit. . Truss Cates. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction- Flood onstruction IVr Flood plain plan Plans resubmitted Mechanical Grading plan X"Review,ready for correctionsfissue Electrical " Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.KL H.O.A.Approval Plans resubmitted Grading IN HOUSE:- Review,ready for corrections/issuc Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub.Wks.Appr " Date of permit issue School Fees Total Permit Fees r '