12-0898 (RPL)P.O. BOX 1504 ii
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
34Titivl 4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:,/_A2-00000898
l
Property Address:
1687 ANDALUSIA
APN:
764-670-032- - -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
86562
Applicant: �)
Architect or Engineer:
aJR
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code and my License is in full force and effect.
Li c nse Class: C53 D35 i e o.: 728796
Datej��7 �� ontractor:
OWNILDER DECLARATION
I hereby affirm under penalty of perjury that I am ex pt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions 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 Contractor's State
License Law (Chapter 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 1, 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.).
(_ 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 I 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:h
Lender's Address� Y\
LQPERMIT
Owner:
TD DESERT DEVELOPMENT
81570 CARBONERAS
LA QUINTA, CA 92253
Contractor:
BUBBLE SPRINGS
P.O. BOX 1046
RANCHO MIRAGE, CA 92270
(760)341-2336
Lic. No.: 728796
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/09/12
------------------
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
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 EVEREST NATL Policy Number 7600001635121
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, or with y with those provisions.
/7— b� A icant:
WARNING: FAILU ECURE ORKERS' C P SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENA AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, 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
aty nd county ordinances and state laws relating to building construc ion, and her uthorize representatives
o his county to enter upo the above-mentioned property for in p o urp
Date• �1� 'nature (Applicant or Agent):
114
LQPERMIT
Application Number . . . . . 12-00000898
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
581.00 Plan Check Fee
377.65
Issue Date . . . .
Valuation . . .
. 86562
Expiration Date . .
2/05/13
Qty Unit Charge
.Per
Extension
BASE FEE
414.50
37.00 4.5000
-----------------------------------------------------------------------------
THOU BLDG 50,001-100,000
166.50
Permit . . .
MECH POOL
Additional desc . .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
2/05/13
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
2/05/13
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 . . . .
33.00 Plan Check Fee..
8.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
2/05/13
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
----=-----------------------------------------------------------------------
Special Notes and Comments
POOL/SPA, BBQ, FIREPIT.
ALARMS/BARRIERS
Application Number . . . . . 12-00000898
----------------------------------------------------------------------------
.Special Notes and
Comments
SHALL BE IN PLACE
AT PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED. 2010 CODES.
-------------------------------------------------------
Other Fees . . .
. . . . . BLDG STDS
--------------------
ADMIN (SB1473)
4.00
Fee summary
Charged Paid
Credited
Due
Permit Fee Total
685.00
.00
.00
685.00
Plan Check Total
403.65
.00
.00
403.65
Other Fee Total
4.00
.00
.00
4.00
Grand Total
1092.65
.00
.00
•1092.65
LQPERMIT
eln.#
Permit #
Project Address:
Cior of, La QUinta
Bulling 8L Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92233 - (760) 777-7012
Building Permit -Application' and Tracking Sheet
' Owner's Name.. _ --
A. P. Number.
Address:
Legal Description:
City, ST, Zip:
Contractor. v�
Telephone:
ProjectDescription:
Address: r
S' 0A4e.VCI.. 0
City, ST, Zip:
p
Telephone:7�3//—
State Lie. #: 7e5 City Lie'. M.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
�w
✓ 0Ad �7
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of ContactPerson: �O ��.: ?L7�
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACIMG
PERMIT FEES
Plan Sets
Plan Cheek submitted
item Amount
Structural Calcs
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance.
Tide 24 Cake.
Plans picked up
Construction
Flood plain plan
Pians resubmitted..
Mecbariical
Grading plan
2'! Review, ready for correctiouslissue
Electrical
Subeontactor List
Called Contact Person
Plumbing.
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Gradiog
IN HOUSE:-
1i° Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
AXP.P.
Pub. Wks. Appr '
Date of permit issue
School Fees
Total Permit Fees