05-2023 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00.002023
Property Address:
APN: 55650 CHERRY HILLS__
Application description: 775-170-024- -
Property Zoning: POOL - RESIDENTIAL
Application valuation: LOW DENSIT
Applicant:
i_r) ,x,1 �1_
Tit!t 4 4 Q"
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I by affirm under penalty of perjury that I am licensed under provisions of CI apter 9 (commencing with
ction.7000) of ivisio - - the Bustness.and Professionals Code, and m - - s - u- or n act.
ce Chas: � Li rise No.: -
COmrecjpl/
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, after, improve, demolish, or repair any structure, prior t0 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 (Chapter1'(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is.exempt therafrom and the basis for the alleged exemption. Any violation of Section 7031;5 by
any applicant foi a permit subjects thwapplicant to a civil penalty of not more than five hundred dollars (8500).:
(_) I, as owner of the property,, or my employees with wages as theirsoie 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; propertywho 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.orimprovemerr is sold within
one year of completion, the owner -builder will have the burden otproving 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'Cods: The Contractors' State License Law does notapply to an owner of
property�who builds or improves thereon,.and who contracts .for the projects with a contractor(s)-iicensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Sac. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty ofperjury 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:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/26/05
Owner:
-----------------------------------
DELORENZO
55-650 CHERRY HILLS
LA QUINTA, CA 92253
Contractor:
-------------------------------
RAZO POOLS
WCC: STATE,FUND
WC: 0022036-2005 01/01/06
Lic. No.: ---------------
-----------------------------------------------
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
AKissued.
I have and will maintain workers' compensation insurance, as required:by Section 37.00 Of the Labor
Code, for the performance of the workfor which this permit is issued. My workers' compensation
Insurance carrierandpoljcy numberare:
Carrier
is'issuad; I shall, not employ arty
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I shouldbecome:subjectto the workers'' compensation provisions of Section
3700 of the labor Co'I shell forthwithi co ply those provisions.
r
ate: 6 1 Applicant: �Z L
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN.EMPLOYER TO CRfMINAL•PENALTIES'AND'CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (9100 000). IN ADDITION TO THE COST OF' COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'&F.EES.
.APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of. Building arta Safety for a permit subject to the
conditions:and restrictions am forth an 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 Le 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 resutt of this application. becomes null and void if work isnot commenced
within 180 days from date of'issuance'of such permit, or cessation of work for 180 days will'subject
permit to cancellation.
1 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 buil4 con5p`Z-_T.
nd herebyauthorize representatives
of this c to enter upon the above-mentioned pro forin
D./- ('�( Signature (Applicant or. Agent):
Application Number . . . . . 05-00002023
Permit
. . .
BLDG POOL PERMIT
Extension
Additional
desc . .
BASE FEE
15.00
2:00
Permit Fee
. . . .
3.62.50
Plan Check
Fee
235.63
Issue. Date
. . . .
3.00
Valuation
. . . .
42000
Expiration
Date
11/22/05
Notes and Comments
Qty Unit Charge
Per
SHALL
Extension
BASE
FEE
252.00.
17.00
6.5000
THOU BLDG
25,001-50,000
110.50
Permit
MECH POOL
Additional.desc
. .
Permit Fee
. . . .
26.00
Plan Check
Fee
6.50
Issue Date
. . . .
Valuation
. . . .
0
Expiration
Date . .
11/22/05
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
11/22/05
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 . . 11/22/05
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
LQPERMrr
A.
Application Number . . . . . 05-000020.23
-------------------------- ---------------------------------------------- --------
Special
------- - -- --- - - -
Special Notes and Comments
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid Credited Due
Permit Fee Total 466.50 .00 .00 466.50
Plan Check Total 261.63 .0.0 .06 261.63
Grand Total 728.13 .00 .00 728.13
LQPERMrr
Bin #.:
City of La. Quin-ta
BuRding sr Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701.2
Building Permit Application and Tracking Sheet
Permit #
.Project Address:
Owner's Name: e
A. P. Number.
' Address: ' L.
.Legal' Description:
City,'ST, Zip: L
Contractor. Zt) t
Tel
Address:(
Project Description:
City, ST, Zip: LO
Telephone: L !
:�{ +:i':2s2:;';:J::) <:::>y'iy:'•ic%<'::
State Lic. # : S
City Lie. #:
f
Arch., Engr„ Designer:
Address:
City, $T, Zip:
U l
Telephone:
Lic. #:
`.? `vs'' .... f>
>
Construction T v
NewProlect type circle one Alter ..Repair Demo
Addn
Name. of Contact Person:
Sq. Ft. c
# Stories:
N• Emits;
Telephone #'of Contact Person:
Estimated Value of Project: add
APPLICANT: DO NOT WRITE BELOW THIS LINE
q
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Ptan:Check submitted
item
Amount
Structural Calcs.
Reviewed, ready,for corrections
Plan Check Deposit
Truss'Cales.
Called Contact Person
Plan Check Balance
Title 24 Catca.
Pians picked up
Construction
Flood plain plan •
flans resubmitted
Mechanical
.Grading plan
2'''Reviev►, ready for correctionsrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up . _
S.M.I.
H.O.A., Approval
Plans resubmitted
.,
Grading
IN IIOUSE:-
'`` Review, ready for corrcctions/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue.
School,Fecs
Total Permit Fees
%
,�- ----POND
_ -\- _ / ,,.
<\r
0-0
000�_ 0
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.00*
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To
SWIMMING POOL
44 DEF
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3ruo-
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0
0
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SPAS
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Es
01
Poo 65
5 :5- C !;'o OF,
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DA'E tilos By G*
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