10-1252 (RPL)4
" P.O. BOX 1504 .VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/16/10
Application Number: 10-00001252 Owner:
Property Address: 51200 AVENIDA CARRANZA KELLY PERRY
APN: 773-061-009-14 -000000- 51-200'AVENIDA CARRANZ
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253 D d
Property Zoning: COVE RESIDENTIAL
Application valuation: 22000
Contractor: NOV 181010
Applicant: Architect or Engineer: COMMON GROUND SWIMMIN P ^ _
72877 DINAH SHORE DR 103-1 qyOFLAQUINIV
RANCHO MIRAGE, CA 9227 Pl1fA?��rE�?EPY
(760)799-9174
Lic. Noo..:: 745278
-------- -----------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Lice Class: D06 C53 Li c se No.: 745278 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Y—
issued.
Date: / — ontract r: _ 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a sighed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I all forthwith co ply v4th those provisions.
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).: ate: Z / - pplican • .
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
lo
.the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WOR -ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION -TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. '
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.).
( ) I am exempt under Sec. , BAP.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
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 information is correct. I agree to comply with all
city and county ordinances ar�dl state laws relating to building construction, and hereby arRltorize representatives
of thi ounty to enter up o he above-mentioned property for inspection purposes
ate: 9natura (Applicant or
Application Number . . . . . 10-00001252
Permit
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
225.00 Plan Check Fee
146.25
Issue Date . . . .
Valuation . . .
. 22000
Expiration Date
5/15/11
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 . . . .
26.00 Plan Check Fee
6.50
Issue Date
Valuation . . .
. 0
Expiration Date
5/15/11
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 . .
5/15/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
-7 ---------------------------------------------------------------------------
EA ELEC PRIVATE SWIMMING POOL
30.00
Permit . . .
PLUMBING
Additional desc . .
Permit Fee . . .
27.00 Plan Check Fee
6.75
Issue Date
Valuation . . .
. 0
Expiration Date..
5/15/11
Qty Unit'Charge
Per
Extension
BASE FEE
15.00
1.00 6.0000
EA PLB FIXTURE
6.00
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 FRONT YARD WATER
FEATURE.
LQPERMIT
Application Number . . 10-00001252
--------------------------------------------=-------------------------------
.Special Notes and Comments
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. EQUIPMENT
ENCLOSURE NOT INCLUDED. 5' SETBACK AT
FRONT P/L APPROVED BY PUBLIC WORKS &
KIRK KIRKLAND.' 2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
Credited
Due
Permit Fee Total 323.00
.00
.00
323.00
Plan Check Total 170.75
.00
.00
170.75
Other Fee.Total 1.00
.00
.00
1.00
Grand Total 494.75
.00
.00
494.75
LQPERMIT
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CITY OF LA QUINTA SUB-CONTRACT044JST 1
w JOB ADDRESS cS�o�� rfQ1??A- PERMIT NUMBER OWN 13UILDER
�r�ner�n
Thmsfor ll . Only 11eirsons appdaring on this list or their employees are u horized 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 buildin permit. For each applicable trade, all information requested below must be completed by applicant. 'On File" is not an acceptable response. {
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riAlt
Corlipany Name
Classification
license Number Exp. Date Cenbr Name
(xxlxxlxx} (e.g. State Fund• MdComp}
PoNey Number
(Format Varies)
Exp. Date
lmaxxlxx)
License Number
Ixxxx)
Exp. Date
(xxhaclxx)
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DRYWALL (C-9) .
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1151
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ROOFRMG (6.39)
SHEET METAL [C43}
FLOURING ICA 81'
GLAZING (C-171
INSULAYTO)M (C-21
SEWAGE DI9P.•(C-421 ,
PAINfiIMG ;�33)
CERAMIC *4 (C-64)
CABIIET� IC�S1
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FENCING (!M3)
LANDSCAPHMG (C-27}
POOL C-531
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_ City of la Quinta
BuUdIng at Safety Dhdsion
(„'� P.O. Box 1504, 78-495 Calle Tampko
11La Quanta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
ddress: Owner's Namei11'i PPL(
mber. Address:escripption- city, ST. Zip:
Contractor. MAIIATelephone
'44,03
Address:
Pnajeat De�xiptiaii:
City. ST. Zip:
Telepieone:/
Stitt Lia # : .�a� %�
Arch., EW.. — iga .
rr .
l
City iia #:
(It nil.
Ad*=:
City. ST. Zip:
Telephone:
State Lit:. #:.
Name of Contact Person /
Construdioa Type: occupancy -
Projekt type (circle one): New Add'n Altar Repair Demo
Sq, FL:$Stories: # Units:
Telephony # of Contact Person:
rsstimrdod Value of Proj
APPLICANT: DO NOT WRITE BELOW THIS LINE
M
Submittal Req'd
Pian Sete
Recd MACIMIG
Plea Cheek submitted
PERMiT FEFS
Item Amount
Structural Cines.
Reviewed, read! for corrections
Pian Clack Deposit
Truss Calcs.
Called Contact Person
Plan Cheek Balance.
Title 24 Calcs.
Plant picked up
Cous traction
Flood plain plus
Plans resubmitted
Mechanical
Grading plan
21! Rerkw, ready for correctionsiJaue
EleetrtCal
Snbtoataetor List
Called Contact Person
Plumbing
Grant Deed
Plana picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for correctiousltssue
Developer impact Fee
Planning Approval,
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date ofpermit Issue
School Fees
Total Permit Fees
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