RPL (07-2720)54840 Avenida Madero
07-2720
7'411 P.O. BOX 1504 ^ `. VOICE 760 777-7012
;Y fi10 8-495 CALLE TAMPICO _ ' ' FAX (760)' 777-7011
:k LA QUINTA, CALIFORNIA 92253 BUILDING &SAFETY DEPARTMENT _ INSPECTIONS (760) 777-7153
•
BUILDING PERMIT .
- ` Date: 10/08/07'
• - APPlicion Number ' 070.0.002720' Owner, _
ti Property Address: 54840 .AVENIDA MADERO '.» ' •: SACUY RESIDENCE - .. _ ;
APN: 774-265-027-20 _000000 Y'`;- 199 MESA DRIVE _
Application description: POOL .- RESIDENTIAL `. »_ COSTA MESA, 'CA
Property Zoning: COVE RESIDENTIAL- P,- ----------- ----- - --- ---
'y f
r 'Application valuation: 12000 f
Contractor: OCT 10 2 /
Applicant: Architect or Engineer: Owner.'.
CITY OF LAQUINTA f
. ' "?
FIN
DEPT - s.
. s
- - - - - - - _ - _ _ _ _ _ _ - _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ --
_ _ _ _ _ _ _ - _ _ _ - - - J
- s LICENSED CONTRACTOR'S DECLARATION " '. ',WORKER'S COMPENSATION DECLARATION; '
-- ,?I hereby affirm under penalty of perjury that Iam licensed under provisions of Chapter 9 (commencing with _ _ I hereby affirmunder penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals 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: License No.: - , } • for by Section 3700 of the Labor Code,for the performance of the work for,which this permit is
_ issued. -
Date: • Contractor. - 1 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 -
'WNER-BUILDER,DECLIIRATION - - 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 Policy Number
' following reason ISec. 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 become 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 beJall
'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 - 700 of the labor Code, I swith comply with those provisions.
that he or -she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7037.5 by -
P
app,icantlfor a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ` ,1"Date: ` . Ap'- plicant _
f" ` .1Ias 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' COMPNS ION 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 ND- IVIL 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 NOD
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, AN TTORNEY'S FEES.
' _ one year of completion, the owner -builder will have the burden of proving that he or she did not build or - - , ,.
' _ f. improve for the purpose of sale.). - - APPLICANT ACKNOWLEDGEMENT -
' r ,
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 contractors) licensed I.' 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
of La'Quinta, its officers, agents and employees for any act or omission related to the work being
.» 7 1• _ , _ - performed under or following issuance of this permit.
.ry Date: U b I •-*Owned' - 2. Any permit issued as a result of this application becomes null and void if work is not commenced
V V- • ' within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject _
CONSTRU TI LENDING AGENCY - permit to cancellation.
- . • •.I her affirm under penalty of perjury that there is a con truct on lending agency for the performance of the _ - I certify that I have read this application and'state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).I city and county ordinances and state laws relating to building truction, and hereby authorize representatives.
Lender's Name - wu" "t- enter upon e above-mentioned property f , .
_ n th b
a of this county to t open s cYon rposes
_z ,__ ,rt - _ _ .r_ SignatureaApplicant-or_Agentl_ - 11
Lender's Address: » ._ . - F„ _. -r Y .y.- '• i- . ,c ,.r.... . _ `wl -
LQPERA1IT
f. ,
. Application Number
. ._ 07-00002720 '
Permit
BLDG POOL PERMIT
Additional desc.'.
. Permit -Fee'
135.00 Plan Check Fee
87:75
Issue Date
Valuation
12000
Expiration Date-.
4/05/08
Qty .Unit Charge
Per
Extension
BASE FEE
45.00
10.00 9.0000
THOU BLDG 2,001-25,000
90.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date
Valuation . . .
. 0
Expiration Date
4/05/.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
4/05/08 .
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 . . .
27.00 Plan Check Fee
6.75
Issue Date . . . .
Valuation
0
Expiration Date
4/05/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.0.0 6.0000
EA PLB FIXTURE
6.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.001. 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00.
-------------------------------
Special Notes and Comments
-------------
POOL, ALARMS/BARRIERS
SHALL BE IN PLACE
LQPERMIT
.
Bin #
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 #
Project Address: 9CM0 V'A A "`vla
Owner's Name: T6v✓t i'v- /_ L11
A. P. Number: r7'74 -2(,5-02 `7
Address:
Legal Description:
City, ST, Zi : dit ✓ /}
I V 4 t. wv1 - t
Contractor: ' 't V)
Telephone. e
`1 _ I 64-6 3d
Address: , D, 9f L
Project Description:
City, ST, ZipV/ MP( / '`ll. t '
,
Telephone: "10 63 0 5
9"101/63o5
G v✓ O o L
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): ew . Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
P
J.
Estimated Value of Project: 0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING .
PERMrr FEES
Plan Sets
Plan Check submitted
'
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Callcd 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
OCT 06. av
.
By .