08-0169 (RPL)IE
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
40 T4ht
Qum&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
1/23/08
Application Number: 08-00000169 Owner: D
Property Address: 81703 ANDALUSIA FREI RERSIDENCE Q
APN: 764-200-999-64 -316813- 81-703 ANDALUSIA
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL JA
Application valuation: 30000 ^I
Contractor:
Applicant: Architect or Engineer: TESERRA gNCE
O�p�'
P.O.-BOX 1280
COACHELLA, CA 92236
l�(760)398-9222
!�T Lic. No.: 656128
-
---------------------------------------------------------------------
--------------------------—
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Pr essianals 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 Class: CS C27 C29 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 tractor: 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 workerscompensation
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 SEA13RIGHT Policy Number BB1080510
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 be me 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 become ubject 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 the La r Code hall fo with 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).:
at
`d licant:
(_) 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 WARNING: FAIL RE TO SECURE WRKE PENSATION 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.).
(_ 1 I, asownerof 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:
Lender's Address:
LQPERMIT
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
t 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 1 have read this application and state that the above info mation is correct. I agree to comply with all
city and county ordinances and state laws relating to building constr tion, and hereby authorize representatives
ofy+ts cou ty to//`enter upon the above-mentioned propert o in ec ion purposes.
Date: � (" Si ature (Applicant or Agent):
Application Number . . . . 08-00000169
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
284.50
Plan Check Fee
184.93
Issue Date
Valuation .
30000
Expiration Date
7/21/08 .
. .
.
{
Qty Unit Charge
Per
Extension
BASE FEE
252.00
5.00 6.5000
------------------------------------------------------------------
THOU BLDG 25,001-50,000
32.50
Permit . .
MECH POOL
Additional desc .
Permit Fee
26.00
Plan Check Fee
6.50
Issue Date
Valuation
0
Expiration Date
7/21/08
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
Expiration Date
7/21/08
.0
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
7/21/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 6.0.000
EA PLB FIXTURE
12.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1'.00 3.000.0
-----------------------------------------------------------------------
EA PLB GAS PIPE
1-4 OUTLETS
3.00
Special Notes and Comments
POOL / SPA ALARMS/BARRIERS SHALL BE IN
LQPERMIT
.Application Number . . . 08-00000169
Permit BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 284.5.0 Plan Check Fee 184.93
Issue Date Valuation . . . . 30000
Expiration Date 7/21/08 .
Qty Unit Charge Per Extension
BASE FEE 252.00
5.00 6.5000 THOU BLDG 25,001-50,000 32.50
-----------------------------------------------------------
Permit . . MECH POOL
Additional desc .
.Permit Fee 26.00 Plan Check Fee 6.50
Issue Date Valuation 0
Expiration Date 7/21/08
.Qty. Unit Charge Per Extension
BASE FEE
1.5.00'
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 Date1. Valuation .0
Expiration Date 7/21/08
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
esc Permit Fee . . . . 33.00 Plan Check Fee 8.25
Issue Date Valuation 0
Expiration Date 7/21/08
Qty Unit Charge Per Extension
BASE FEE 15.00
2.00 6.0.000 EA PLB FIXTURE 12.00
1.00 .3.0000 EA PLB WATER INST/ALT/REP 3.00
1'.00 3.000.0 EA PLB GAS PIPE 1-4 OUTLETS 3.00
---------------------
------------------------------ ---------------------------
Special Notes and Comments
POOL / SPA ALARMS/BARRIERS SHALL BE IN
LQPERMIT
s
Application Number 08-00000169
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED (NO
WALLS)
Fee summary Charged Paid Credited. Due
-----------------------------------
Permit'Fee Total 388.50• OQ .00 388.50
Plan Check Total 210.93 .00 .00 210.93
Grand Total 599.43 .00 .00 599.43
LQPERMIT
+' 1111111111111
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
42 4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
08-00000169
Property Address:
81703 ANDALUSIA
APN:
764-200-999-64 -316813-
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
30000
Owner:
FREI RERSIDENCE
81-703 ANDALUSIA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/23/08
Contractor:
Applicant: Architect or Engineer: TESERRA y x
P.O.-BOX 1280
COACHELLA, CA 92236
(760) 398-9222
LiC. No.: 656128 9
-
------------------------------------------------------------------------------------------ - - - - - —
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 Professionals Code, and my License is in full force and effect.
License Cl s: C8 C27 C29 LicenseNo.: 656128
Date: tractor:
WNER-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 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 _ 1 1, 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.).
I—) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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: Pk
Lender's Address:
LQPER111IT
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 SEABRIGHT Policy Number BB1080510
I certify that, in the performance o the work for which this permit is issued, I shall not employ any
4m'
n any manners s to b come subject to the workers' compensation laws of California,
e that, if I s uld ecom subject to the workers' compensation provisions of Section
the La r od � h comply with those Provisions.
ate:licant:WARO SECURE W 'COMP SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJR TO CRIMINA PENAL ND 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 abo information is correct. I agree to comply with all
city and county ordinances and state laws relating to building con uc . , and hereby authorize representatives
of y�As co my to enter upon the above-mentioned pro y r ins a on purposes.
DDate:� ature (Applicant or Agen .
Application Number . . . . 08-00000169
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
284.50 Plan Check
Fee
184.93
Issue Date
Valuation
. . . .
30000
Expiration Date
7/21/08
Qty Unit Charge
Per
Extension
BASE FEE
252.00
5.00 6.5000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
32.50
Permit . .
MECH POOL
Additional desc . .
Permit Fee . . . .
26.00 Plan Check
Fee
6.50
Issue Date . . . .
Valuation
. . . .
0
Expiration Date . .
7/21/08
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
7/21/08
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 . .
7/21/08
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 ALARMS/BARRIERS SHALL BE IN
LQPERMIT
Application Number . . . . . 08-00000169
----------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED (NO
WALLS)
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 388.50 .00 .00 388.50
Plan Check Total 210.93 .00 .00 210.93
Grand Total 599.43 .00 .00 599.43
LQPER 11T
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # I
V
Project Address: Ig— 3 Atir94GcTl
Owner's Name: �� T
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: `—
Telephone:
Address: 0RoxProject
Description:
City, ST, Zip: 691LOAE LLIV CA, qzZ- fO
oCJ OL,
Telephone: 3-1, 1. Z,
State Lic. # : S
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Name of Contact Person:
Project type (circle one):(New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: aT5 --d)J 7
Estimated Value of Project: O
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
110
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" 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:-
''" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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