RER (12-0169)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000169
Property Address: 56685 MERION
APN: 762-023-025- - -
Application description: REMODEL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation:` 500
Ta9v 4 4 Q"
Applicant: Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjur that I arm licensed un ' pr isions of Chapter 9 (commencing with
Section 7000) of Division 3 of the B sine a Professio Co e, and my License is in full force and effect.
License CI s: 18626 is se No.: 4018205565
Date: ^ Contractor: ,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 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, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
fhe 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, 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 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
Owner:
MILLARD RESIDENCE
56685 MERION
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/24/12
Contractor:
ACTION POOL SERVICE IIS+;
PO BOX 2626 E'
LA263 QUINTA, CA 92253 2? 212
Lia. No.: 4018205565
CITY CF !.A QUINTA
Ff� �t�?�CE ^ _4a?
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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.
_ 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 4950 Policy Number AMERICAN CO
_ I certify that, in the performance of the wor or which this permit is issued, I shall not employ any
person in any manner so as become b act to the workers' compensation laws of California,
and agree that, if I should a ome subj ct o e workers' compensation provisions of Section
00 of the Lab o Co all forth it c ply with those provisions.
Date: ' : 7—Applicant:'
WARNING: FAILURE TO SECURE WO /ERS' 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 above informatio is correct. I agree to comply with all
city and county ordinances and state laws relating to building structio , nd reby authorize representatives
of this coun y to nter upon the above-mentioned pro erto i spectio r as.
Date: !/ 'Z`f Signature (Applicant or Agent):
Application Number . . . . . 12-00000169
Permit . . . ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . . 16.50 Plan Check Fee
4.13
Issue Date . . . . Valuation . . .
. 0
Expiration Date 8/22/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
-----------------------------------------------------------------------------
1.50
Permit . . PLUMBING
Additional desc .
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation . . .
. .0
Expiration Date 8/22/12
Qty Unit Charge Per.
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
i ----------------------------------------------------------------------------
Special Notes and Comments
LAY PLUMBING & ELECTRICAL PIPES FOR
FUTURE SPA @ SOUTH SIDE YARD. 6-2" WATER
LINES, 2-1" AIR LINES, 2-1" ELECTRICAL
LINES, 2-3/4" ELECTRICAL LINES.
=
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Other Fees . . . .. . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------------------------------------
Due ..
-----------------
Permit Fee Total 34.50 .00 .00
34.50
Plan Check Total 8.63 .00 .00
8.63
Other Fee Total 1.00 .00 .00
1.00
Grand Total 44.13 .00. .00
44.13
LQPERMIT
--_Action Pools, Inc.
P. Cl: Box 2626
Springs, CA 92263
a
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR ONSTRUC ION
DAT Z � 2D I gY
10
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CA
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M Action Pools, Inc.
P. O. Box 2626
"1-1!m Springs, CA 92263
U..
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR ONSTRUCTION
DAT Zo12 BY
0
RII-Ir6 i 61 So
S (�a 0 -5e n -i a ri.r o,j rc.
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Crtyof La Who
Building 8L Safety. Division
P.O. Box 1504,78-495 Calle Tampico
ia.Quinta, CA 92253 -:(760) 777-7012
Building Permit A lication and Tracking Sheet
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ProjectAddtrss:.�
A. P. Niunber.
Address:
Legal Description:
City, ST, Zip: � q � /NTACf
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Contractor. C joov }'UU,Jt lL�l a c` .-To L
Telephone:
Address:��'7�. o a
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Project Description: 4A
City, ST, Zip: /A sP (L1rj 65 CA g2Z(13
A s A � a
Telephone: ?to — 3aS=qfS-V
City Lic. #
LZ r-3 cis
State Lia 4: S (.8 Ce 2�Cp
Arch.- Engr., Designer.'
�..— �• .two es
Address: Address:
1` L
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contarx Person: /NAtZ /
Construction Type: • Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Tel hone # of Contact Person: v
eP 7laa —,32� �iSSD Estimated Value of Project: t1,
APPLICANT: DO NOT WRITE BELOW THIS LINE
N Submittal Req'd Recd TRACMG PERhIIT FEES
Plan Sets Plan Check submitted Item Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact PersonPlan
Check Balance
Title 24 Calm
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Giading plan
2" Review, ready for correctionsfissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
ML
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review; ready for correctionsAssae
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees