RPL (13-1495)78195 Masters Cir
13-1495
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
tr1 rvrr G7 rr
13-00001495
78195 MASTERS CIR
770-360-013- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
7500
T4t!t 4 4 a"
Architect or Engineer:
u4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
D°
NOV 5 2013
CITY OP LA QUINTA
FINANCE DEPT.
VOICE (760) 777 -7012 -
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/22/13
Owner:
AGNEW, DAN J & KIMBERLY R
78195 MASTERS CIR
LA QUINTA, CA -92253
Contractor:
LEAK DETECTORS
P.O. BOX 727
THOUSAND PALMS, CA 92276
(760)773-9070
Lic. No.: 618116
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
1 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 3 of the Business and Professionals Code, and my License is in full force and effect.
I have and willmaintain a certificate of consent to self -insure for workers' compensation, as provided .
License Class: C36 C53 License/No.: 618116
- for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date: ontractor: i /!
)t >2 S- ' 1f— 1d 1'1 / 1
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 workerscompensation -
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 SECURITY NATL' Policy Number SWC1025162 - -
following reason (Sec. 7031.5, Business and Professions Code: Any city or countythat 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 Ishould become subject 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
3700 of the Labor Code, I shall forthwithcomply 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).:
// I—V
Date: -Applicant: 1 O `. V V " 1
(_ 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 WORKERS' COMPENSA ON 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 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
I, 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-
he-7044,
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,. -. - -
(_) 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
-
performed under or following issuance of this permit.
- Date: Owner:
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 -, • ' -
' CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction 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.). - .
city and county ordinances and state laws relating to building construction, and hereby authorize representatives';,: ', -i ,.
of this county to enter upon the above-mentioned property for inspection purposes. '
Lender's Name:\
Date: t lignature (Applicant or Agent):
Lender's Address:
- -
LQPERMIT
LQPERMIT
Application Number . . . . . 13-00001495,
Permit POOL 2013
Additional desc.
Permit Fee . . . 178.75 Plan Check
Fee
.00
Issue.Date valuation
. . .
. 0
Expiration Date 5/21/14
Qty Unit Charge Per
Extension
1.00 178.7500 EA MISC POOL/SPA
178.75
Special Notes and Comments
REMODEL ONLY TO EXISTING POOL, SPA AND
WATER FEATURE [DENISE POELTLER
ENGINEERING] THIS PERMIT DOES NOT
INCLUDE RELOCATION OF EXISTING EQUIPMENT
***ANTI -ENTRAPMENT DRAINS REQUIRED TO BE
INSTALLED PER CBC/CHSC*** ALARMS.AND
BARRIERS REQUIRED TO BE INSTALLED AT
PRE -PLASTER INSPECTION. 2010 CALIFORNIA
BUILDING CODE.
November 22, 2013 3:43:09 PM AORTEGA
----------------------------------------------------
Other.Fees .. BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, POOL
97.24
Fee summary Charged' Paid Credited
Due =
Permit Fee Total 178.75 .00
.00
178.75
Plan Check Total .00 .00
.00
.00
Other Fee Total 98.24 :00
.00
98.24
Grand Total 276.99 ._00
.00
276.99
Bin #a.,,
City of La Quintom
Building &r Safety Division
PBox ox , -5 CJ116 Tampico
1504 78 49
La Quinta, CA 92253 - (760) 777-7012 Nov 1-8
Building Permit Application and Tracking'sheet CIV O 1-1`'I"
Permit #
Project Address: MP(I+e4s. C'Xi'2—
S;4
Owner's Name:
A. P. Number:
Address: IM C,
Legal Description:
City, ST, Zip:
Contractor:telephone:
T" g -S
Address: -7 2 7
Project Description:
City, ST, Zip: jU
6 AN
EAAS G N.. 8 IYO
Telephone:7
667 3ft07
State Lic.#:
City Lic. #.-.
Arch. rE,gr.*,*'Pesigne'r: ^ISf= ELMj
Addr,s .
City., ST, Zip:
Telephone:
.......
Construction Type: Occupancy:
State Lic.#: 946
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: tVIE LW NVj
Sq. Ft.:
# Stories:
# Units:
Telephone kof Contact Person: —7 f2 I) Z-7 2 % -Z, C7
Estimated Value of Project.o
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Rcq1d
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural C21CS.
Reviewed, ready for corrections
lop
:Plan Ch . eck Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 CaIcs.
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 correction ssu
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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