RPL (12-0428)50640 Mandarina
12-0428
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: E 2 0.000}04'2'8
Property Address:
50640 MANDARINA
APN:
776-200-004- - -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1 20000 1.
T -&t
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
e
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busines Professionals Code, and my License is in full force and effect.
License Cla C4, 10 7, 2 License No.: 656128
ate:/ Contractor:
OWNER -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 sheds 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).:
(_) 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.).
1 _ 1 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 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
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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/18/12
Owner:
ROY D d Q
50640 MANDARINA
LA QUINTA, CA.9 '
APR 2 01012
Contractor: CFTMAFLA QVIj1lT
TESERRA NCE DE
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
LiC.. No.: 656128
.l
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.
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for theperformance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are: -
Carrier EVEREST NATL IN Policy Number 7600006481121
I certify that, in the performa a of th work for which this permit is issued, I shall not employ any
person in any manner so a o b me subject to the workers' compensation laws of California,
and agree that, if I should c e subject to the workers' compensation provisions of Section
70 f the Labor Code, I forthwith comply with those provisions.
plicant: -
WARNING: FAIL R1ToECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL 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 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 abov for ion is correct. I agree to comply with all
city county ordinances and state laws relating to building co tion, and hereby authorize representatives
o is county ent r upon the above-mentioned property for i tion purposes.
Datenature (Applicant or Agent):
Application Number .
. . . . 12-00000428
Permit .. . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
207.00 Plan Check Fee
134.55
Issue.Date . . . .
Valuation . . .
. 20000
Expiration Date
10/15/12
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
THOU .BLDG 2,001_25,000
162.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date
Valuation . . .
. 0
Expiration Date
10/15/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
EA MECH FURNACE >100K
.11.00
--------------- ---------------------------------------------.------------1--
Permit . . .
ELEC POOL PERMIT=RES
Additional desc .
Permit Fee . . . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation
0
Expiration Date
10/15/12
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
10/15/12
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. INCLUDES 116
L.F. 1 1/2" GAS .
LQPERMIT
Application Number . . . . . 12-00000428
,,Special Notes and Comments
LINE FOR HEATER'. ALARMS/BARRIERS SHALL
BE IN PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. 2010
CODES.
-----------------_----------------------------------------.------------------
Other Fees ,,. . . . . . BLDG STDS
ADMIN (SB1473)
1.00
Fee summary Charged Paid
Credited
Due
Permit Fee Total 311.00.
.00
00
311.00
Plan Check Total 160.55
.00
.00
160.55
Other Fee Total 1.00
.00
.00
1.00
Grand Total 412.55
.00.
.00
472.55
LQPERMIT
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Cray of. La Quina ..
8p#WMg or Safety D#vfslon .
P.O. Boz.1504, 78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 177-7012
BuildingPermit - ticadon an
App d Tracking Sheet
Permit # :
Z"
Project Address: j v '
N --DA e %,IJA
Owner's Name:. 26
A P. Number
:•
Address:
Legal Description:
Contracto .
Cry. ST. Zip: (_ 7
1 a ,Jrq c. Z.Z
Telephone:
Address: 96 0 0
- k
Project Description:
City, ST, Trp: r
-T2--Z
Telephone.- (j3 q
State Lia #: $ . /
^ 97z ZZ
Z • 0ty Lie., #;
Arch, Engr., Designer.
Address:
City, ST. Zip:
Telephone:
Stack Lia #: '
Construction Type:. Occupancy:
Project type (circle on New Add'n Aber Repair Demo
Name of Contac;PUM'-
v r Z
OtATelephone
Sq, Ft ; Stories:
T-# Units:
# of Corttaet Person: 0 0 Z` gytmaW Value of Project7-0i 000
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal RWd Ree'd TBACIMG PERMIT FEES
Plan Sets
Pian Cheek submitted y2 Item Amount
Slrgdaha Csles.
Reviewed, ready for corrections Plan Check Deposit • .
Truss Cale$.
Called Contact Person Plan Check Balance
Title 24 Cafes.
Plans picked up Construction
Flood plain plan
Plans resubmitted.. Mechanical
Giadiag plan
2'! Review, ready for correctionsressue Electrical
Subeontaetor List
Caned Contact Person Plumbing
Grant Deed,
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
2" Review, wady for corrections/issoe Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. AppF
Date of permit issue
School Fees
Total Permit Fees