RPL (11-1079)P.O. BOX 1.504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY. DEPARTMENT.
BUILDING PERMIT
Application Number:11-O'00'OlOZ-996
Contractor: U OCT /h
Owner:
Property Address:
473-MONTANA�WY-'
ROSSI
APN:
649-5007023- - -
49673 MONTANA WAY
Application description:
POOL - RESIDENTIAL
LA QUINTA, CA 92253
Property Zoning:
LOW, DENSITY. RESIDENTIAL
-------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION -
Application valuation:
28000
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760);777-7-153.
Date: 10/03/11.
officers
Contractor: U OCT /h
�Q�f
Applicant: Architect or Engineer:
TESERRA'
P. 0. aox 1280 CPtyOFfgQ�IR1T
-COACHELLA, CA 92236Ff,VA VCE
(760)398-9222, f3�pT
rlpc
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 30the Busines . nd Professionals Code, and my License is in full force and effect.
_ 1'have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Cf
License Class: , 10 , 27 2 License No.: 656128
for by Section 3700 of the Labor Code, for the performance bf the work for which this permit is
issued.
Date: 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 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 7600006481111
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 b 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 beco su ect 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 of the Labor Code, I shall f r 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).:
ate:
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 ofproperty 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, 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(sl 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
f L O 'nt t a ents and em Io ees for any act or omission related to the work being
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
o a aiso e w , g p Y
• performed .under or following issuance of this permit. '
2. Any permit issued as a result of this applicationbecomes null and void if work is not commenced •
within 160 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 thjbuildinbcon
Lonpurposes. s correct. I agree to comply with all
city and county or 'na es and state laws relating tod hereby authorize representatives
of thiscounty t n upon the above-mentioned pr
Katt �� ature (Applicant or Agent): "
Application Number 11-00001:079
Permit BLDG POOL PERMIT
Additional desc .
Permit Fee 271.50 Plan Check
-Fee
176.48
Issue Date . . Valuation
28000
Expiration Date 3/31/12
Qty. Unit 'Charge. Per
Extension
BASE FEE"
252.00
3.00 6.5000 THOU, BLDG.25,001-50,000
19.50
Permit . . .. MECH POOL
Additional desc ..
Permit Fee 26.00 Plan Check
Fee
6.50
Issue Date Valuation
. . . .
0
Expiration Date ": 3/31./12
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 3/31/12
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 3/31/12
Qty Unit Charge Pere
Extension
BASE FEE
15.00
2.00 6.00.00'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
DEMO OLD POOL, BUILD NEW POOL/SPA USING
LQPERMIT ...
'Application Number . . . . . 11-00001079•
----------------------------------------
-----Special Notes and Comments
EXISTING.PLUMBING.ALARMS/BARRIERS SHALL
BE IN PLACE•AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. 2010
CODES..
----------------------------------------------------------------------
Other Fees . . . BLDG STDS ADMIN (SB1473)
2.00
Fee summary, Charged Paid
Credited
Due
Permit Fee Total 375.50 .00
.00
375.50.
P1an.Check Total 202.48 .00
.00
202.48
Other Fee Total 2.00 .00
.00
2.00
Grand Total 579.98 .00
.00
579.98
LQPERMIT - '
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Bin #
.. City of La.- Quints
Building az Safety.. Division
P.O. Box 1504,,78-495 Calle'Tampico
La Quinta, CA 92253 - (760) 777-7012 ,
Building Permit Application and Tracking Sheet
Permit #
O'� R
'
Project Address:. 9 6 3 p„! rLUOwner's
Name: SS
A. P. Number:
Address: / 9 G 3 3 w
Legal Description:
City, ST, Zip: LA u„Vr^ 2 Z$7
Contract r.
Telephone: >•N��x':>�'�'i��' : %';Je:•. �-'. " ,<,
Address: c2 - 0 O _
Project Description:
City, ST, Zip: 2 2 3 G
EW oo
Telephon . >2(, 0 3 8 sz 2
z C n`!£Ji ::; ~6y f y:': C.:i?:%...
'•: `mac .r:�.?>,,:...:.r:.:.?�. .. .�;,
NRC,n/1 ' n/
State Lic. # : 4191 2-9
City Lic. #:
Arch., Engr., Designer:
Address: .
City, ST, Zip:
Telephone:
'm'va y �M.uy
State Lic. #: h,v:z> 4e r
Name of Contact Person: Uo �n
Construction Type: Occupancy:
Project type (circle one). Ne Add'n Alto Repair Demo
Sq. Ft.:
# Stories: # Units:
Telephone # of Contact Person: 2 $ O 23 (g
Estimated Value of Project: g 00
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TVA . CKING PERMIT FEES
Plan Sets
Plan Cheek submitted
Q
qlx. Item Amount
Structural Colts.
Reviewed, ready for to
Plan Check Deposit
Trus Calcs.
Called Contact Person
Plan Check Balance
'title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'' Review, ready for correctionsti sue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3.4 Review, ready for correctionshaue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees