RPL (09-0989)61305 Living Stone Dr
09-0989
APN: 764-280-999-6 -300236-
Application description: POOL - RESIDENTIAL
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 18000
Applicant:
Tav 4 4 Q"
Architect or Engineer:
alp
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
JEBOUSEK
61-305 LIVING STONE DRIVE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX, (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/14/09
O
Contractor:
TESERRA
P.O. BOX 1280 O
COACHELLA, CA 92 6 1
(760)398-9222 C11
Lic. No.:,656128 s
qy Op9 .
eFr A°stir
-------------------------------------------------
------------------------ - - - - -- -- ,---- - - - - --
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DEC ATION ,
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
1 hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of'the ass" Profess s Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for wor compensation, as provided
License -Class- C8 , 10, 27 ; 2 % nse No.: 656128
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is .
aterontractor:
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
NER-BUILDER DECLARATION
insurance carrier and policy number are:.
I hereby affirm under penalty of perjury that a exempt from the Contractor's State License Law for the
Carrier .SEABRIGHT Policy Number BB1080510
following reason (Sec. 7031 .5, Business a rofessions 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 rep any structure, prior to its issuance, also requires the applicant for the
person in any man compensation la of
ornia,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 one sub' t' compensation provisitionLicense
Law(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or -
thekers'
aX00 of the abor Code, I sh fo ' 'ons.
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: plicant:
(_ 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 WORKE ' C 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 PENAL ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or herown 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,
(_ 1 I am exempt under Sec. , BAP.C. for this reason
•
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
h k '
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
of La Qwnta, its officers, agents and employees for any act or omission related to t e wor bang
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 fro _ of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation. ' 2
certify that I have read this applica d state tha a above information is correct. I agree to comply with all
city and county ordinances and state la relafi o ilding construction, and hereby authorize representatives
of th' co y to enter upon above -m n roperty for inspection purposes.
ate..
b te: f nature (Appl' t 01
Application Number 09-00000989
Permit . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . 189.00 Plan Check Fee
122.85
Issue Date . . Valuation
18000
Expiration Date . 3/13/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
16.00 9.0000 THOU, BLDG 2,001-25,000
----------------------------------------------------------------------------
144.00
Permit MECH POOL
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee
6.50
Issue Date Valuation . . . .
0
Expiration Date 3/13/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 11.'0000 EA MECH FURNACE >100K
-----------------------------------------------------------------------------
11.00
PermitELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 45.00 Plan Check Fee
11.25
Issue Date Valuation . . .
0
Expiration Date 3/13/10
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 3/13/10
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, GFI•ELECTRICAL OUTLET & GAS
LQPERMIT ..
Application Number. . . . . .
09-00000989
-- -- - -- -
Special Notes and Comments
STUB FOR FUTURE BBQ, 20 L.F. 1
1/2" GAS
LINE. ALARMS/BARRIERS SHALL BE
IN PLACE
AT PRE -PLASTER INSPECTION. EQUIPMENT
ENCLOSURE NOT INCLUDED. 2007 CODES.
-------------------.-----=--------------------'------------------------------
`• Other Fees . . . . . . .
BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid
Credited
Due
----------------- ----------
Permit Fee Total 293-00
----------
.00
.00
293.00
Plan Check Total .148.85
.00
.00
148.85
" Other Fee Total 1.00
.00
.00
1.00
Grand Total 442.85
.00-
.00
442.85
LQPERMIT -
-
-
Bili #
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 #
n Q
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Project Address: jr S
Owner's Name: e
A. P. Number: / R(t1,d
Address: Q -IVW4 9707 _
Legal Description:
City, ST, Zip:
Telephone:
Contractor: 2--5c
Address: g( — ( Q0 A VE
Project Description: L. O
City, ST, Zip:
e rfRi CAI -T
Telephone:
State Lic. # : City Lic. #: _
.
Arch., Engr., Designer:
li/ w)e
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair .Demo
Sq. Ft: 5 8 # Stories: # Units:
Name of Contact Person: `
Telephone # of Contact Person:. f%
Estimated Value of Project: K
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
q
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Cheek 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.L
HAA. Approval:
Plans resubmitted
Grading
IN HOUSE:
Jr° 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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*ALL DECKING EXPANSION JOINTS FOR
REPRESENTATION ONLY, FIELD LAYOUT
WILL VARY.
CITY OF (A QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE!:. —4f BY T
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IOCIL AUIDMG OB ARILENFAT THE -OF 198UMMEOF P9eR.
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SCALE DATE DRANRIBY SOLD BY ED CHECKBV
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CONSTRUCTION AUTHORIZATION
SELECTIONS
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