RPL (05-1700)79868 Memorial Pl
05-1700
P.O. BOX1504
78-49$ CALLELLE TAMPICO
LA QUINTA, CALIFORNIA 922$3
BUILDING & SAFETY DEPARTMENT
Application Number: — / 'l O U
Applicant:
Applicant's Mailing Address:
0o r^/ % /\� 0- i-0 K
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
. Date: 3
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 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
de, and my License is in full force and effect.
icense Class C.- 53 License No(/ 'A-!-)\ O S S
Zate 5 S — Contractor--
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 she is licensed pursuant to the provisions of the Contractors' 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 fora permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 or 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.).
U 1, 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.).
L) I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' 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
Xof 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 career,arid policy numbeEge:
mer +P.�r ` �, ��vci Policy Numbed/ f 111 i S 1 S
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of. the Labor Code, I shall
forthwith comply with those provisions.
to °5 S S Applicant" t`; c_\. \ i>2 -z
WARNING: FAILURE TO SECURE 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.
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 4/4
Lender's Address
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 Ouinta, 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 above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction,_ and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
Date 15 S Signature (Applicant or Agent): �� _ Q Irv-\, Q
-----------------------------------------------------.--------
y Application Number . . 05-00001700
Permit BLDG POOL PERMIT
Additional desc
Permit Fee 225.00
Issue. Date . . .
,,Expiration Date 10/30/05
Plan Check'Fee 146.25
Valuation . . . . 22000
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
20.00 9.0000
THOU BLDG
2,001-25,000
.180.00
Permit . . . . . .MECH
POOL -
Additional desc
Permit Fee
26.0.0.
Plan Check
Fee
6.50
Issue Date
Valuation
.
. 0
Expiration Date
10/30/05
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
10/30/05
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
10/30/05
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 ONLY. ALARMS/BARRIERS
SHALL
BE IN PLACE PRIOR TO,PRE-PLASTER
INSPECTION. EQUIPMENT
ENCLOSURE
NOT
INCLUDED IN PERMIT.
.Fee summary f Charged
Paid Credited
Due
Permit Fee Total
329.:00
.00_
.00
329..00
Plan Check Total
172.25
.00
.00
172.25
Grand Total
501.25
.00
.00
501.25
Q
Bin #
City .of La Quinta
Building &r Safety Division
P.O. Box 1504, 78495 Calle Tampico
La Quinta, CA 92253 - (760) 777 -7012 -
Building Permit Application and Tracking Sheet
Permit #
Project Address: 9 ._ <?(<, i M e t t OR:, A I P
Owner's Name:
A. P. Number:
Legal Description:
Contractor:-?" s...........:
Address:
City, ST, Zip: GR
MOW;
City, ST, Zip, PoA , S sZ, s c. a. 9 7-2- LP
P o ey I
S
Telephone: ltc(>) 3.ay - "2-'7
;r,.'`'v:;%;
State Lic. # : LAS kO S S
City Lic. #:
/
Arch., Engr., Designer:
Address: Li I- 9 Z f Q ao c a.,,
z 1 Q
• t
City, ST, Zip: P,,,
Cl ZZ I I
'
Telephone: t-76 '1' 9 -OC, 5"7 `';: s '>''` :>;.f :y %> ?;%:fs
:•u','iir fif r'.::};;:::;i%i',crU.J %"fir/ k
State Lic. #: L `:<E??3'•.<'>z:>>€«<>>z''`:?>: >:»
I I
Nelle® of Contact Porson- C_c I" CP. 1 w
Construction Type: Occupancy:
'
Project type (circle one) New Add'n Alter . Repair Demo
8 : Pt:: #8 torim: # Units:
Telephone # of Contact Person: o-
LI MME,ti ed V ue r
Af NT€ D® NOT WFIITF- OF -LAW THIS LINE
# Submittal Re 'd Ree'd TRACVJNG
PERMIT FEES
Z Plan Sets
Pian Check submitted S
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Coles.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Pians 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.
Nib, Wk®. Apps
Mete of permit lfimu@
--
School F@@s
Total Permit Fees
6 block Wall•
+1211
l.., ,: : • TE pa Raised 12°
6' block Wall 8 ft. '
04
i
29 ft. 0 in.
'
•
•
w
,, .• -
: •
,
r
D
j
'•Y
T
. guf
-
.f
'b
♦ '• -
'
7
L'4`" _ .. _',
%'y
_ 4". _
-
4
Colored Salt Concrete.
y ` =.t
R
1t ,•.k .ry` r ti_'r ..
;..A RE -INSPECT ION- FEE
..? ,may. _-
`• Y ' l ' ' '1
.1i ,• -'"
, . i ..
,F x..
r4
1 '
'
J w 3
•
r
`fir, `V}i t•.Y 't -
,
' Y
2
Qi .A
•s:".
f
M -
,- -
!, -t ..
; _
. _ {+.rF. ... "
.i" t.•. t''Q
: ti s ♦"' 3 "ra. ,
` ' ••
+ i '
7.
,... - ,.'4} i
wl, a
r. >.},
7-•i
• -
H: •,
',. b a t +
j
y ` :XJ ^
..
' 'r
j
-, a ) ,
''
i. ..
s{` L'
420 filter _ i_= [L
,' • - --
,i .fit
a r o`
'
,+ k
.
i s * is
7 i ,
INSPECTION
6' block Wall
•
- ,* ;.
04
i
•
•
w
p
,
r
D
j
'•Y
T
-
O17 e'er
♦ '• -
.. - +t
;..A RE -INSPECT ION- FEE
.--
t., ,•:
_. 0F.`$30
WILL BE CHARGED IF THE'APPROVED
_
3
1 Pump 2 lip.
Y
, PLAN ND JOB
S.A CARD ARE -NOT ON
4..F..-_400000Heater=
420 filter _ i_= [L
,' • - --
,, >. '
_.., T`HE.•. SIT,E .FOR=,A- SCH.EDULED. - r.3 •.
INSPECTION
•
1y}+`
"
NO.;EXCEPTIONS!
• .
. 4' ..°
•"
_ • R ., .i- ,. .:
,..
-
Gas/
-•
,_. :;
." _ ," ', y _ .. •
elec
^,
v
:Miles ;
CD
..
r ,
0
<<<
•
Fred Waring
, ,
-
i'!
a
,• ' • -
Rich Parzinsky Pool Const. •
Designed by:
05-408
Pete Agras
SCALE: 1/8" = 1'
P.O. Box 897
Phone: -760-324-5827
_ Steve P.
Desi ned
9
79-868 Memorial PI
r.
-
-
P.S.
CA,92263• Fax: '760-324-7287
5/2/2005
for:
LQ
t