RPL (06-2474)79859 Memorial Pl
06-2474
A -
P.O. BOX 1504
.78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00002474
79859 MEMORIAL PL
604-501-020-11. -24197 -
POOL -RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000
( ?444vQ",
Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Business and Professionals Code,and my License is in full force and effect.
License Class: License No.:
Date: 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 theapplicant for the
permit to file a signed statement that he or she is 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).:
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
. 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 _ ) 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.).
(_ 1 I am exempt under Sec. , B. fo this re son
nary
u .r C(
I hereby affirm under penalty of perjury that there
work for which this permit is issued (Sec. 3097,(1
Lender's Name:
Lender's Address:
LQPER 11T
LENDING AGENCY v
in lending agency a performance of the
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/21/06-
Owner:
/21/06Owner:
ALICI'A FERNANDEZ
79-859 MEMORIAL PLACE
LA QUINTA, CA 92253.
(760)360-8674 D
Contractor: JUN 212006
Owner
CITY OF LA Q4IIMTA
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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.
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 .
insurance carrier and policy number are:
Carrier --- -------------------Policy Number -
I certify that, in the performance of the work for which th'rmit is is ed, I shall not employ any
person in any manner to become ubl tot ore rs' c ensation laws of California,
and a ree that, if, 1 ould ome eabject t th orkers' co sation provisions of Section
3,700 f the LaboCall forthwith c with those visions.
Date: _VI 4,111 /( %rApplica
WARNING: FAILURE TO SECURE WORKERS' SqMPJiNS,4TION COVERAG UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE TIE CIVIL FINES UP O NE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TOT E C T OF COMPENSATION, A AGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, IN T, AND ATTORNEY'S FEE .
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 0 days will subject
permit to cancellation.
I certify that I have read this application and state that the o ac
ormati4correree to ly with all
city and county ordinances and state laws relating to bu' ing uction,riz entatives
of this cou ty to nter upon the above-mentioned pro• rt o{ion p
Date: gnature (Applicant or Age
Application Number .
. . . 06-00002474
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
207.00 Plan Check Fee
134.55
Issue Date
Valuation
20000
Expiration Date
.12/18/06
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
12/18/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
EA MECH FURNACE >100K
11.00
----------------------------------------------
T.
Permit ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation
0
Expiration Date
.12/18/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
EA ELEC PRIVATE SWIMMING POOL
30.00
PermitPLUMBING
Additional desc :..
Permit Fee
33.00 Plan Check Fee..
8.25
Issue Date . . . .
Valuation
0
Expiration Date
12/18/06
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 ALARMS/BARRIERS SHALL BE IN
LQPERMIT
SO
i
Bin #
City of La Quints
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
I,
Project Address: 0AE- P—)4L(
Owner's Name: A\ ` e I' A,
A. P. Number:
Address: 19 — 8J01MEMO?-jam P1ACE
Legal Description:
ity, ST, Zip: 1A Qty I t. A 9'22:S73
Contractor: w iV '? ,
Telephone: tPQ- MPo. Gr
Address: 901 - P ! V al &&C4 A__ PI AL►
roject Description:
City, ST, Zip: Uq- DLV) Q -rA
Telephone:
State Lic. # : City Lic. #:
Arch., Engr., Designer:
Fez v,- e
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Yy#S% „
a i„
Construction Type: Occupancy:
Project type (circle one): New d'n Alter Repair Demo
tlName of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: CpO
stimated Value of Project: c
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd 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:-
''d 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
-
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB° -ADDRESS / I L
PERMIT NUMBER OWNER l I e re2 - BUILDER • OW1 L
This form shall be posted on the job with'the Building
Inspection Card at all times in a conspicuous place. Only -persons appearing on this list or their employees are authorized 'to work '
on this job.• Any changes to this list must be approved
by the Building Division prior to commencement of'work. Failure to comply will result in a stoppage of work and/or the voidance
' of building, permit. For each applicable trade, all information requested below must be completed
by applicant. "On File" is not an acceptable response. . r ...'
:
Trade / Classification ................................
... ....................
..........................::::. Contractor..........................................................State..
Contractora:.License....:...............................................................Workecs..Co:m
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n.ansur.ance............... ..................::.
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Polis NumberComPan
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT..
APPROVED.,
FOR CONSTRUCTION
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OWNER/BUILDER INFORMATION
Dear Property Owner
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies.for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the. City or County. They are also required by law. to put their license number on all permits for which they
apply.
If you plan to do your own work,. with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, ,and such persons are- not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their
work personally or through their own employees, without a' licensed contractor or'subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be -signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed.owner-builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
PROPERTY ADDRESS
PERMIT NUMBER(S)