09-0881 (RPL)P.O. BOX 1504 .
78-495 'CALLE 'TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 0-9700000881
Property Address: 81370 RUSTIC CANYON DR
APN: 764-2801999-173 -300236-
Application description: POOL RESIDENTIAL
Property Zoning: MEDIUM HIGH DENSITY RES
Application .valuation: 20000
Applicant:
Architect or Engineer:
I A-
4. ei Qu&&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE
(760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
BRENNER
81370 RUSTIC CANY N
D VE
LA QUINTA, CA 9225
�t-D
Contractor:
.�� �117
TESERRA
P.O. BOX 1280
=�
COACHELLA, CA 92236
'P
(760)398-9222
Lic. No.: 656128
i
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under,penalty of perjury that I am licen.der provisions of Chapter 9 (commencing with
Section 7000) of.Division 3 of the Bus' i Pr f s o.als Code, and my License is in full force and effect.
License C : ' 8 , 10 , 2 7 , 2 icense No.: 6 5612 8
e: tractor:
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that am exempt from the Contractor's State License Law for the
following reason ISec. 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 (commericing 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.).
(_ 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, andwho contracts for 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
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: r `
LQPERMIT
Date: 8/18/09
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 Ina ,¢s' number are:
Carrier SEABRIGHTPolicy Number BB1080510
I certify that,p formance the work for which this permit is issued, I shall not employ any
person in nne o as to b come ct to the workers' compensation laws of California,
and agree I shou ecom t t e workers' compensation provisions of Section
�b0 of tr Code, I s it o ply with those provisions.
pWARNING: FAIL RE TO E WO 'COM GE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYERIMIN ALTIES AND CIVIL FINESUP O ONE HUNDRED THOUSAND
DOLLARS ($100,000). IION 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 to that t ove inf rmation is correct. I agree to comply with all
city and ordinances and state laws re in to building ruction, and hereb authorize re resentatives
of this unt er on t above -mentione ert rposes.
te: Sig ture (Applicant or
, f
• Application Number .
. . . . 09-00000881
•
-
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee
207.00 Plan Check
Fee
134.55
Issue Date
Valuation
. . . .
20000
Expiration Date
2/14/10
Qty Unit Charge
Per
Extension
BASE FEE
45.00.
18.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
162.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check
Fee
6.50
Issue Date . . .
Valuation
0
Expiration Date
2/14/10
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
2/14/10
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
2/14/10 _
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 6.0000
EA PLB FIXTURE
12.00
1.00 3.0000
EA PLS 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, 25 L.F. 1 1/2"
GAS LINE &
LQPERMIT
Application Number . ... . . 09-00000881
----------------------------------------------------------------------------
Special Notes and Comments
ELECTRIC STUB OUT FOR FUTURE APPROVED
APPLIANCES. ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.2007
CODES.
----------------------------------------------------------------------------
Other Fees .- . . ... . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
Credited
Due
Permit Fee Total .311.00 :00.
.00
311.00
' - Plan Check Total 160.55 .00
.00
160.55
Other Fee Total 1.00 .00
.00
1.00
Grand Total 472.55 .00
.00
472.55
Bin #
City of. La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # „/),�
�J
OR
Project Address: 1- 0 Rv/S C ltN /1112-
Owner's Name: 13re�
A. P. Number:�(�loqtA zzyf— %( 73
Address: Y -31-3X R uSfi~C e471 (fj) rY-1-
Legal Description: CJ
Contractor:;
S42rrrk
Address: 6--60
City, ST, Zip /
Telephone:
Project Description: f �+
City, ST, Zip: '1 23 f.
Telephone:
..
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: x
State Lic. #:�
Name of Contact Person: - C\n t/-) CC ledo
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: JV6
# Stories:
T# Units:
Telephone # of Contact Person:(706) 50-- 07
Estimated Value of Project: -
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
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
2nd 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:-
3'd 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
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(I) TAIENOTICE THAT NOL ARD[9U61EMlOCATOS ARE SUBELTTO AGCEPTANCEOF
LOCK B W ONG OBARTMFRT AT THE TIME OF 64UNCE OF PB✓lOT.
M WET DOWN CO/OtETE SFMAT LFASTTWICE DAEYFOI SEVEN DAYS AFTER SHELL IS WTAUED. -
• (N) AGREE THATTESERRA S NOT RESPONSEE FOR MERGROOOCOORIDMSOR OSWM
AMD ANY DAMAGE TO CURBS, SOEWK/m• DRIVEWAYS•LAYMORanHE R OBS N THE ACCE59MEA
(5) SEE THAT ALL FECNG.GATES. AND OARAOEDODRBLM LOCKCOCIES FORAPOOL00-WJM
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BADDRESS TRILOGY CITY LA G
ZONE OFFICE
6173 TRACT. _ PAGE - BOOK ,
MAP BOOK PAGE N0. ' �•
4 _ . irk - - - , • -MAIL ADDRESS
CONSTRUCTION OFFICE PHONE NO.
L L SCALEDATE DRAWN BY SOLDBY
1 I ii°=1' L Z9-01 MB JEFF
JOB REVISIONS
T� a, 3
4 ,
' SELECTIONS
I; CONSTRUCTION AUTHORIZATION STONE T�1nwMotlJrAH-1 JA+LfaT f�
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