RPL (09-0038)P.O., BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T-4bt 4 4 Q"
Application Number: 09-00000038
Property Address: 79454 MISSION DR W
APN: 649-590-025- - -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 30000
Applicant:' Architect or Engineer:
Q/
�I
-------------------------------------
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalt of perjury thal�j am lic seff'u der provis' Chapter 9 (commencing with '
Section 7000) of Division 3 o Business al d P fe i s C ,and my License is in full force and effect.
License C ss' CS C27 C29 ense No.: 656128
te: tractor:
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perjur I exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business nd rofessions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or r air ny structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that h or he is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing Section 70001 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
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 contracts for,the projects with a contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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:
ZOERINK
79454 MISSION DRIVE WEST
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/16/09
U1 �� �� !
0 2009
WORKER'S COMPENSATION DECLARPTION GITtr 0F: �.,..a:�= '(!d•�f;
I hereby affirm under penalty of perjury one of the following declarations: I e;c.y �.i,r•. _rpq•
I have and will maintain a certificate of consent to self -insure for taorkerslcomperisation�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 an icy number are:
Carrier SEABRIGHT Policy Numb BB1080510
I certify that, in the rforman a of the wo which this permit is issued, I shall not employ any
person in any man r so as o beco s le the workers' compensation laws of California,
and agree that, if I s uld be ome ' c e orkers' compensation provisions of Section
3700 of the Labor Co sh I o w' y with those provisions.
115_ate: pplicant:
WARNING: FAILURE TO SECURE W RKER ' CO NLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIM NAL P ALTIES AND CIVIL FINES UP TO ONEHUNDRED THOUSAND
DOLLARS ($ 100,000). IN ADDITION T HE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, TEREST, 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 a ploye or any act or omission related to the work being
performed under or following issuance f this per it.
2. Any permit issued as a result of this app ation bec i mes null and void if work is not commenced
within 180 days from date of issuance o uch per it, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that thea ve i fo �ti n is co I agree to comply with all
city and county ordinances and state laws relating to building u ion, a ereby authorize representatives
of thi;.coygty10 enter ppogAKe above-mentioned property for ' ction gpses.
(Applicant or Agent):
Application Number . . . . . 09-00000038
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
284.50 Plan Check Fee
184.93
Issue Date
Valuation . . .
. 30000
Expiration Date .
7/15/09
Qty Unit Charge
Per
Extension
BASE'FEE
252.00
5.00 6.5000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
32.50
Permit . . .
MECH POOL
Additional desc . .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
7/15/09
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
7/15/09
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
7/15/09
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
---------------------------------- -----------------------------------------
Special Notes and Comments
POOL/SPA, WATER FEATURE,BBQ, 150 L.F. 2"
LQPERMIT
Application Number . . . . . 09-00000038
-------------------------------------------------------------------------
Special Notes and Comments
GAS LINE TO SERVICE APPROVED
APPLIANCES.
ALARMS/BARRIERS SHALL BE IN PLACE
AT
PRE -PLASTER INSPECTION.
----------------------------------------------------=-----------------------
Other Fees . . ... . . . . .
BLDG STDS ADMIN (SB1473)
2.00
Fee summary Charged
---------------------------
Paid
----------
Credited
--------------------
Due
Permit Fee Total 388.50
.00
.00
388.50
Plan Check Total 210.93
.00
.00
210.93
Other Fee Total 2.00
.00
.00
2.00
Grand'Total 601.43
.00
.00
601.43
LQPERMIT
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Bin #
City of. La Qulnta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
c/
A
Project Address: �i'Q/j j"
Owner's Name: 20 u
A. P. Number: C
Address:79— `/S ss'/U/11 /—Po
Legal Description:
City, ST, Zip: f
Contractor:ra
Telephone:ILI
Address: b-- iE�/—/
Project Description:
City, ST, Zip:
Telephone:
State Lic. # : 5 City Lic. #:
Arch., Engr., Designer:
Address:
- -5-/ ta7rC-IT Tai)&
City, ST, Zip:
Zi"Pwv.0
Telephone:
State Lic. #:
Name of Contact Person:Frnnv� ceiecj&n
Construction Type: Occupancy:
Project type (circle one) Ne Add'n Alter Repair Demo
Sq. Ft.: UV JD
# Stories:
I
# Units:
Telephone # of Contact Person:(76p S C)-- UZ $
Estimated Value of Project:30
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
I ` iii
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person.
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7n° 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