08-0306 (RPL)P.O. BOX 150.4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
6 (_ Application. Number: --
08-0000.0306
Property Address:
81697 RUSTIC CANYON :DR.
AP.N:
764-280-999-36 - -300237- ' ..•
Application description:
POOL - RESIDENTIAL
Property Zoninq:
MEDIUM HIGH DENSITY RES
.Application valuation:
30000
Applicant: Architect or Engineer:
I
�n
M
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BLADEN RESIDENCE
81-697 RUSTIC CANYON DR
LA QUINTA, CA 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and R ofessionals Code 'and my License is in full force and effect.
license Class: C8 C27 C29 4.License No.: 656128
i
Dater 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, 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 (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).:
(_) 1, 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
r 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
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.I. - -
Lender's Name:
Lender's Address:
LQPERDIIT -
Contractor: D
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic_ No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/15/08
-------------------
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have andwillmaintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for theperformance 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 BB1080510
1 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 to become subject to the workers' compensation laws of California,
and agree that, if) should become subject to the workers' compensation provisions of Section
3700 of the Labor C , I shall f rthwith comply with those provisions.
Date:,l���(`Applicant:' .
WARNING: FAILURE TO SECUR COMPENSATION COVERAGE IS UNLAWFUL,, AND SHALL '
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITIONTOTHE 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 inform tion is correct. I agree to comply with all
city and county ordinances and state laws relating to building constructi n, and hereby authorize representatives
of this county to enter upon the above-mentioned property ins ectio purposes.
Date:. ignature (Applicant or Agent):
Application Number
08-000003.06
Permit . .
BLDG POOL PERMIT
Additional desc .
Permit Feer
284:50 Plan Check Fee
184:93
Issue Date . . . .
Valuation
\
29680
Expiration Date '.
8/13/08
Qty Unit Charge
Per
Extension
BASE FEE
252.00
5:00:. 6.5000
THOU BLDG 25,.001.-50;000
-12,50 -
Permit . . .
MECH POOL.
Additional desc .
Permit Fee
26.00 Plan'Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
8/13/08.
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
8/13/08
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
8/13/08
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' 08-00000306
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee 15.00 Plan Check Fee .00
Issue Date Valuation . . . . 320
Expiration•Date 8/13/08
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. 48" X
20' L.F. CITY'STANDARD BLOCK WALL.
Fee summary Charged Paid Credited Due
Permit Fee Total 403.50 .00 00 403 50
Plan Check Total 210.93 .00 .00 210.93
LQPERMIT '
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 #
0-/4'
Project Address: e(�
U�t% aR.
Owner's Name: 1 J
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: ���c�,_—��
Telephone:
Address: 96 - I cu Ay6 -S-•�; •
Project Description:
City, ST, Zip: C01 = C l ZZ_ Cr
ot7 S
Telephone: s`/s- `I Z L�
J T#` t
City Lic. #:
W• i9' G '� ZD L e S TZD
State Lic. # : : 5 ?
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:;
-g
'
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: J LSSL
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: o
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cafes.
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 resu
Grading
IN HOUSE:-
VU
'`d Review, orrceorrrections/issu
Developer mpact Fee
i
Planning Approval
Called Cont ers�.6-v i
A.I.P.P.
Pub. Wks. Appr
Date of perm t issue
School Fees
By
Total Permit Fees
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OWNER RESPONSIBILITIES
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OWNER T0:
.
GOLF CART/
1 I HEAPPROXIMATEA N 0 00 UT ON DA OF EXCAVATION.
) DETERMINE T ELEVATION F POOL OR SPA AT LAYOUT Y
c2) TAKE NOTICE THAT POOL AND EQUIPMENT LOCAT10 S RE SUBJECT TO ACCEPTANCE OF
OPT. EXERCISE
to
I
O-
LOCAL BUILDING DEPARTMENT AT (H TIME OF ISSUANCE OF PERMIT.
ESE
ROOM ED
-.
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1
1(4}
-1-
I
ea IF�T
3 WET DOWN CONCRETE SHELL AT LEAST TWICE DAILY FOR SEVEN DAYS AFTER SHELL IS INS d ALLED.
AGREE THAT TESERRA IS NOT RESPONSIBLE FOR UNDERGROUND CONDITIONS OR OBJECTS
AND ANY DAMAGE TO CURBS, SIDEWALKS, DRIVEWAYS, LAWNS. OR OTHER ITEMS IN THE ACCESS AREA. `