08-1293 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Q"
Application Number: c-08$ ..0001293`l
Property Address: 61830 MESA CT
APN: 764-280-999-61 -300237-
Application description: POOL - RESIDENTIAL
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 25000
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 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 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 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.).'
(_) 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 contract or the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). -
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
1/atDe: 10 q110 k caner: F�e .�. �1/ , A e
i
.. 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address: iP(
LQPERMIT
Owner:
BEN SMITH
61830 MESA COURT
LA QUINTA, CA 92253
Contractor:
Owner
�J
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/12/08
_
WORKER'S COMPENSATION DECLARATI
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 Policy N
I certify that, in the performance of the, for hich this permit is issued, I shall not employ any
person in any manner so as to become subje to the workers' compensation laws of California,
and agree that, if I should become/subject td the workers' compensation provisions of Section
37_90 of the LabgL.0�, I shall forthwith jfomply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 id if work is not commenced
within 180 days from date of issuance of such permit, or cessatio of work for 180 days will subject
permit to cancellation.
certify that I have read this application and state that the above information ' correct. I agree to comply with all
city and cou ty ordinances and state laws relating to building construction, d hereby authorize representatives
Of this y to nt r upon eabove-mentioned pr for in �pection rposes.
ate: l� / �% nature (Applicant or Agent): j
Application Number . . . . . 08-00001293
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
252.00 Plan Check
Fee
163.80
Issue Date . . . .
Valuation
. . .
. 24825
Expiration Date
5/11/09
Qty Unit Charge
Per.
Extension
BASE FEE
45.00
23.00 .9.0000
- -----------------------------------7----------------------------------------
THOU BLDG 2,001-25,000
207.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check
Fee
6.50
Issue Date . . . .
Valuation
.
. 0
Expiration Date
5/11/09
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
5/11/09
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
5/11/09
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
Permit . . . . . .
WALL/FENCE PERMIT
'LQPERMIT
Application Number . . . . . 08-00001293
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 15.00 Plan Check
Fee
.00
Issue Date Valuation
. . .
. 175
Expiration Date 5/11/09
Qty -Unit Charge Per
Extension
BASE FEE
15.00
-------------------------------------------7--------------------------------
Special Notes and Comments
POOL/SPA, 7 L.F. 6' EQUIPMENT WALL, CITY
STANDARD, GAS STUB -OUTS FOR FUTURE
APPROVED AND PERMITTED APPLIANCES.
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION.
Fee summary Charged Paid Credited
------------------------------------=--------------------
Due
Permit Fee Total 371.00 .00
.00
371.00
Plan Check Total 189.80 .00
.00
189.80
Grand Total 560.80 .00
.00
560.80
LQPERMIT
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Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
U Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 3 0 Ii%
Owner's Name:,
A. P. Number:
Address: "C630 / A 154
Legal Description:
City, ST, Zip: U! 117A ! Z ZS^3
Telephone: /- i G o- li 9 4 - 3--74-o
Contractor: O's t�-e
Address:
Project Description.5�A s
City, ST, Zip:
Telephone:
State L
State ic. # : City Lic. #:
Arch., Engr., Designer:50
Address: R,
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: 61c*ccupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: ��K L ��—
Sq. Ft.:
1 # Stories: # Units:
Telephone # of Contact Person: 7? 1 7 Estimated Value of Project: 1is00 t7
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Rec'd
TRACIONG
Plan Check submitted
PERMIT FEES
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
2id 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:-
1. 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
X,
IM
Q
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS (a1'3 -'ND A964 6oar PERMIT NUMBER OWNER ',&-_/J BUILDER F-'-_-�
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.
Trade Classification
Tr / as
Contractor
::..:: . .:::..:::..77
::::<';:: <:<>S..Contractor's
tate.license - . .:........;>.
Wo�ke�s Com en.sation _Insurance.' : ;.:.
City Business License: . .
Company Name
Classification
(e.g. A, B, C-8)
License NumberEExp.
(xxxxxx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)fJEpti%
t✓ ^ 5
g/ ZEA H
CONCRETE (C-8)
FRAMING (C-5)
STRUCT. STEEL JC=51)
MASONRY (C-29)
PLUMBING (C-36)
' [„ ��'J�
L ` S
/� �
S gf /D
SC�l9,t
� 0' Z 90
<
LATH, PLASTER (C-35)
DRYWALL (C-9)
HVAC IC -20)
ELECTRICAL (C-10) : ..
0 Lo
ROOFING (6-391.::
SHEET METAL (C43)
FLOORING (C=15):
GLAZING (C-17).
INSULATION (C-2) .
SEWAGE DISP. (C-42)
PAINTING (C=33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27) '
POOL (C-53)
6-0-60 C'?au1/• fc-G-
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