07-1499 (RPL)P.O. BOX 1504.
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Applicant:
Architect or Engineer:
wk
----------------- I
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am icensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business a sionals Code, and my License is in full force and effect.
LicensB
e Cla s: C8 C27 C29 License No.: 656128
_ 1
Date: Contractor.
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, alter, improve, demolish, or repair any structure, prior to its issuance, alsorequires 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 (commencing 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).:
(_) 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, 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. , B.&P.C. for this reason
_ Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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:
BEIMA RESIDENCE
81-673 RUSTIC CANYON DR.
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012-
FAX
77-7012FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/21/07
----------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 carrier and policy number are:
Carrier SEABRIGHT Policy Number BB1070510
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as become subject to the workers' compensation laws of California,
and agree that, if I should be _me subject to the workers' compensation provisions of Section
3 00 of the Labor 1 forthwith comply with those provisions.
Date: X64L4plicant
WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES URTO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO 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 state that the above in ormation is correct. I agree to comply with all
city and county ordinances and state laws relating to bu"din con uction, and hereby authorize representatives
of thisc?ur1ty to @nter upon the above-mentioned ction purposes.
ta
'
.Date: gnature (Applicant or Agent): —
Application Number:
07-00001499 ,
Property Address:
81673 RUSTIC CANYON 'DR
APN:
764-280-999-34 2.3,00237 -
Application description:
POOL- RESIDENTIAL
Property Zoning:
MEDIUM HIGH DENSITY RES.
Application valuation:
25000
Applicant:
Architect or Engineer:
wk
----------------- I
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am icensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business a sionals Code, and my License is in full force and effect.
LicensB
e Cla s: C8 C27 C29 License No.: 656128
_ 1
Date: Contractor.
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, alter, improve, demolish, or repair any structure, prior to its issuance, alsorequires 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 (commencing 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).:
(_) 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, 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. , B.&P.C. for this reason
_ Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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:
BEIMA RESIDENCE
81-673 RUSTIC CANYON DR.
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012-
FAX
77-7012FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/21/07
----------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 carrier and policy number are:
Carrier SEABRIGHT Policy Number BB1070510
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as become subject to the workers' compensation laws of California,
and agree that, if I should be _me subject to the workers' compensation provisions of Section
3 00 of the Labor 1 forthwith comply with those provisions.
Date: X64L4plicant
WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES URTO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO 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 state that the above in ormation is correct. I agree to comply with all
city and county ordinances and state laws relating to bu"din con uction, and hereby authorize representatives
of thisc?ur1ty to @nter upon the above-mentioned ction purposes.
ta
'
.Date: gnature (Applicant or Agent): —
.::Application Number
07-00001499
Permit . . . .BLDG
POOL PERMIT
Additional desc .
Permit Fee
252..00 :- Plan Check Fee
163.80
Issue Date
Valuation . .
24600
Expiration Date ..
11/17/07
Qty Unit -Charge
Per.
Extension
BASE FEE
45.00
23.00 9:0000
THOU BLDG 2.,001-25„000
2n -7 -nn
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . .
Valuation . .
. 0
Expiration Date
11/17/07
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
11/17/07 '
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
11/17/07
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
Permit . . .
WALL/FENCE PERMIT
LQPERMIT
- - '
Application Number . . . . . 07-00001499
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit.Fee 15.00 :
Plan Check.Fee
.00
Issue Date',.
Valuation
400
Expiration Date 11/17/07
Qty Unit Charge Per "
Extension
BASE
FEE
15.00
--------------------------------------------------------
Special Notes.and Comments
---------------
POOL,'SPA, ALARMS/BARRIERS SHALL.BE
IN
PLACE AT PRE -PLASTER INSPECTION.
25' X
�-
48" CITY STANDARD BLOCK WALL.
Fee summary Charged
Paid
Credited
Due
Permit Fee Total 371.00
.00
.00
371.00
Plan Check'Total 189.80
.00
.00
189.80
Grand Total 560.80
00
.00
560.80
Bin #
City ®f La Quinta
Building 81 Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quiilta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:-
Owner's Name:
A. P. Number:,--rAI
Address:
Legal Description:
Contractor:Telephone:
City, ST, Zip:
�.�
Address: 0.. 0)Z5
Project Description:
City, ST, Zip: Cog-641;-LLA 64- _ '77,2--3(a
p2oL
Telephone: �� — ZZZ
w12A4,
State Lic. # : City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:t
Y 4
State Lic. #:
Name of Contact Person: J �S4-7 , Z
Construction Type: Occupancy:
NL�vi.J
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: O Z --O .
Estimated Value of Project: Zsp�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
5
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Eli
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:-
w, ready for corrections/issue
Developer Impact Fee
Planning Approval
ontact Person
IDEateof
A.I.P.P.
Pub. Wks. Appr
permit issue
School Fees
Total Permit Fees
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OR OTHER ITEMS N THE ACCESS AREA
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5 SEE THAT ALL FENCING, GATES AND
GARAGE OOR E
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STER INSPECTION,
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it I
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I 7 TAKE NOTICE THAT THIS RA:
DRAWING IS THE
SOLEI PROPERTY OF TESERRA AND THAT ANY
T '
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SERRA IS
PROHIBITED BY LAW.
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OWNER APPROVES PLAN, POOL,
EQUIPMENT IPMENT LOGATIO
NS AND HAS READ THE RESPONSIBILIRE5 AND NOTICES ABOVE
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DIG
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,
iCT
r
DECK ❑ C❑L R
,
PFIECaUTS
NIT"
JAN
DY
b
I
UNDERGROUND
UND
I
tEBBr/P
I_AS
P
LA t:e it—
,
MASONRY
t
1
SIGNATURE
E
It _
I
A
I
DECK
_ nage
and
irrigationa
1I
o
n for P
la
tern -an
d pots, ,
by
DRAINAGE
PRE -PEBBLE others, unless otherwise noted.
,
I
I+
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,
-
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,
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L
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