06-2553 (RPL)+ .r 1111111111111111111111111 1111111111 25
P.O. BOX 1504 _
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00002553
Property Address:
60915 AZUL CT
APN:
764-270-999-88 -300234-
Application description:
POOL - RESIDENTIAL
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
25000
Applicant: Architect or Engi
T4'!t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
D °
JUL 051006
ne r: CITY OF 6A QUINTA
FINANCE QFPT
--------------------------------------------------
LICENSED TRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I ' ensed under provisions of Chapter 9 (commencing with
Section 700 9) of Division 3 of the Business Professionals Code, and my License is in full force and effect.
License 5 License No.: 658996
ontractor:
vessions
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that Iexempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and 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 _ I 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
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.).
(_) 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 contractors) 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: PC
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/28/06
Owner:
KAREN MIKKELSON
60915 AZUL COURT
LA QUINTA, CA 92253
Contractor:
FAMILY POOL CONSTRUCTION
P O BOX 283
LA QUINTA, CA 92247
(760)564-3655
Lic. No.: 658996
------------------
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 STATE FUND ' Policy Number 1344032-06
I certify that, in the perfo ce of the work for which this permit is issued, I shall not employ any
person in any mann as to become subject to the workers' compensation laws of California,
and agree that, i sh Id become subject to the workers' compensation provisions of Section
�f700 of the I shall orthwith comply with those provisions.
ate: ry,V, pplicant:
WARN G: FAILURE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJE T AN EMPLOYER TO CRIMI L PENALTIES 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 su h permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify ha 1 have read this application and state that th information is correct. 1 agree to comply with all
city an cou y rdinances and state laws relating to b ' ng construction, and hereby authorize representatives
ofth' t enter upon th above-mentioned pro rt r inspection purposes.
ate: S' ature (Applicant or Agent):
' Application Number . . . . . 06-00002553
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 252.00 Plan Check Fee 163.80
Issue Date . . . . Valuation . . . . 25000
Expiration Date . . 12/25/06
Qty Unit Charge Per Extension
BASE FEE 45.00
23.00 9.0000 THOU BLDG 2,001-25,000 207:00
----------------------------------------------------------------------------
Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date 12/25/06
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 12/25/06
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 12/25/06
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
LQPERNIIT
Application Number . . . . . 06-00002553
------------------------------------=---------------------------7-----------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged
----------------- ----------
Permit Fee Total 356.00
Plan Check Total 189.80
Grand Total 545.80
LQPER IrT
Paid Credited Due
---------- ---------- ----------
.00 .00 356.00
.00 .00 189.80-
.00 .00 545.80
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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Lic #658996
rBn #
City of La Quinta .
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
'
Permit #
x,55 3
Project Address: J
Owner's Name: -VW&/v 1JJ
Address: Q ql S AaL) , -
City, ST, Zip:LL.
Telephone: j c
Project Description: (� [�
A. P. Number:
Legal Description:
Contractor:,
Address: 3
City, ST, Zip: :-
Telephone:
State Lic. # : ; : $ City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle;one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: —2
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Re Id
Rec°d
TRACKING .
PERMPr FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Caics.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plan
2nd 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
15q 5 ry