08-1990 (RPL)P.O: BOX 1504
_,78-.495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&ht 4-4-0"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
08-00001990
Property Address:
81553 RUSTIC CANYON DR
APN:
764-280-999-54 -300236-
Application description:'
POOL - RESIDENTIAL
Property ZpninD:
mF1 wm u:TrH PENSITY' REQ
Application valuation:
15000
Applicant:
Architect or Engineer:
Owner:
RON & ANN BRUCKNER
81553 RUSTIC CANYON DRIVE
LA QUINTA, CA 92253
Contractor:
GARY & SONS
67621 CACTUS APPLE
DESERT HOT SPRINGS,
(760)251-8945
Lic. No.: 866518 -
VOICE (760) 777-7012
FAX (760) 777 -7011 -
INSPECTIONS (760) 777-7153
Date: 12/31/08
lfi'j 06 2009
LA
LICENSED CONTRACTOR'S DECLARATION
-------------------------- —� -
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury that 1 am licensed under provi ons 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 d Professionals Code, hd 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
License Class: C53 Lic se o.: 866518
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�/ issued.
/bate: ► 1 ln/ �l Tactor:
�
11�f.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
W UILDER ECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am e t from the Contractor's State License Law. for the
Carrier DELOS INS CO Policy Number 02DI 220010101
following reason (Sec. 7031 .5, Business and Pro ssions Code: Any city or county that requires a permit to
_ I certify that, in the performance of he work for which this p rmit 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 to
come subject to the wo cers' compensation laws of California,
' - permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I shou ec
a subject to theme rke ' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
-PIGI
0 of the Labor C I s a
forthwith com ly 'it hose 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).:
te:pplicant•
1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is riot intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARE TO SECURWORKERS' C MP S TION 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 RENALTI 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 CGIOST 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.).
APPLICANT ACKNOWLEDGEMENT
1 _) 1, as owner of the property, am exclusively cbntracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
- property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed •
1. Each person upon whose behalf this application is made, each person at whose request and for '
pursuant to the Contractors' State License Law.).
.whose benefit'work is performed under or pursuant to any permit issued as aresult of this application,
1� 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City -
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
11
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 wor is t commenced
within 180 days from date of issuance of such permit, or cessation of wor f 80 days will subject
- permit to cancellation. � /rr/'a/I
I certify that I -have read this application and state that the Dov formation is c0gree to comply with all
city and countyordinances and state laws relating to bulyX,/ g c struction, an 1�ieorize representatives
of this cougty tQ enter upon the above-mentioned propert fo spection p ose
(Applicant or
Application Number .
. . . . 08-00001990
Permit
BLDG POOL PERMIT
Additional desc .
Permit Fee
162.00 Plan Check Fee
105.30
Issue Date . . . .
Valuation . . .
. 15000
Expiration Date ...
6/29/09
Qty Unit Charge.
Per
Extension
BASE FEE
45.00
13.00 9,0000
THOU BLDG 2,001-25,000.
117.00
Permit . . .
MECH POOL_
Additional desc .
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date
Valuation . . .
. 0
Expiration Date
6/29/09
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
45:0.0 Plan Check Fee
11.25
Issue Date
Valuation
0
Expiration Date
6/29/09 .
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 . . .
27.00 Plan Check Fee
6.75
Issue Date
Valuation . . .
. 0
Expiration Date
6/29/09
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
SPA ONLY. ALARMS/BARRIERS SHALL BE IN
LQPERMTT
Application Number . . . 08-00001990
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED..
Fee summary Charged Paid Credited Due
----------------- --- - -- ---------- ---------- ----------
Permit Fee Total 260.00 .00 .00 260.00
Plan Check Total 129.80 .00 .00 129.80
Grand Total 389.80 .00 .00 389.80
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24
Bin # f�
City of La Quinta
Building U Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
qV
Project Address: �L r`
Owner's Name:
U T
A. P. Number:
Address: "
Legal Description:
City, ST, Zip:
Contractor:P
Telephone:
Address:LEI (alL-CaaLls 1 e
Project Description:
City, ST, Zip:
Telephone• 7 U
State Lic. # : C City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: _µ °
State Lic. #: y A"
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one) ' A&Fn Alter Repair Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project: 00.
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 Chetk Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
tad Review, ready for correctionslssue
Electrical
Subcontactor List
Called Contact Person
Plumbin€: °
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees