07-2602 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Applicant:
T,ityl
BUILDING & SAFETY DEPARTMENT
Architect or Engineer:
BUILDING PERMIT
Owner:
BEDNARCZYK RESIE
81-889 RUSTIC CA
LA QUINTA, CA 92
r�L
Contractor:
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: 9/26/07
DR.
' LIC SED CONTRACTOR'S DECLARATION
Application Number:
.
Property'Address:
_07-00002602 Y~
81889__RUSTIC CANYON'DR
APN:
764-280-999-52 -300237-
Application description:
POOL - RESIDENTIAL
Property Zoninq:
MEDIUM HIGH DENS.T.TY RFS
Application valuation:
30000 .
Applicant:
T,ityl
BUILDING & SAFETY DEPARTMENT
Architect or Engineer:
BUILDING PERMIT
Owner:
BEDNARCZYK RESIE
81-889 RUSTIC CA
LA QUINTA, CA 92
r�L
Contractor:
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: 9/26/07
DR.
' LIC SED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I m licensed under provisions 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 an Professionals Code, and 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 Cl a sr C8 C27 C29 License No.: 656128
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
---
`issued.
Date! Contractor:—
_ I have and will maintain workers' compensation insurance, as required by Section 3706 of the Labor
�---
Code, for the performance of the work for which this permit is issued. My workers' compensation
' OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier SEA 3RIGHT - Policy Number BB1070510
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit 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 as become subject to the workers' 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 should be me subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or
3700 of the Labor Co I a forthwith comply with those 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):
�e. B Q� Applic�_ant:
(_ 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 -
WARNING: FAILURE TO SECURE W ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an ownerof property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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 COST 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.). .r - -
APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting 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 whobuilds 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 a result of this application,
I _ I 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
.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
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 af
s correct. I agree to comply with all
city and county ordinances and state laws relating to W id hereby authorize representatives
of this county to enter upon the above-mentioned prop rt oses.
Date:rr 6ignature (Applicant orAgentli
Application Number .
. . . . 07-00002602
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee,
284.50 Plan Check
Fee
184.93
Issue.Date . . . .
Valuation
29680
Expiration Date
3/24/08
Qty. Unit Charge
Per
Extension
BASE FEE
252.00
5.00 6.5000
----------------------------------------------------------------------------
THOTT RT -Dr, ?.5; 001 -c;n, n n n
32.50,
Permit
MECH POOL.
Additional desc .
Permit Fee . . .
26.00 Plan Check
Fee
6.50
Issue Date
Valuation
. . .
. 0
Expiration Date
3/24/08
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
3/24/08
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..
3/24/08-
/24/08Qty
QtyUnit 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 . . . . . 07-00002602
Permit WALL/FENCE PERMIT
Additional desc .
Permit.Fee 15.00
Plan Check
Fee
00
Issue Date
Valuation
320 ..
Expiration Date 3/24/08
~ Qty Unit Charge Per.
Extension
BASE FEE
15.00
Spec:i.a] Notes• and C;nminPnts
POOL, SPA, ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION. 48" X
20" L.F. EQUIPMENT WALL CITY -STANDARD.
Fee summary Charged Paid
Credited
Due
Permit Fee Total 403.50
_00
.00
403.50
Plan Check .Total 210.93
.00-
.00
2i0.93
Grand Total 614.43
.00
.00
614.43.
y
LQPERMIT
- .
Bin #
Colty of La Quint
Building u Safety Division
Permit #P.O. Box 1504, 78-495 Calle Tampico ,--
Q La Quinta, CA 92253'- (760) 7J7-7012
Building Permit Application and Tracking Sheet
Project Address:'F/—'" L Owner's Name:
A. P. Number: Address:
Legal Description: City, ST, Zip:
Contractor:
.� Telephone:
Address: 12-6 Project Description:
City, ST, Zip: -3
.Telephone:
State Lic. # : City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: Construction Type: O.cu anc
_ P Y:
State Lic. #: Project type (circle one): New Add'e. Alter. Repair Demo
Name of Contact Person. Sq. Ft.: # Stories: #Units:
Telephone # of Contact Person: Estimated Value of Project: 5(9,020
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd TRACKING PERIIIIT FEES
Plan Sets Plan Check submitted Item Amount
Structural Calcs. Reviewed, ready for corrections Plan Check Deposit
Truss Calcs. Called Contact Person Plan Check 3alance
Energy Calcs. Plans picked up Construction
Flood plain plan Plans resubmitted Mechanical
Grading plan 2' 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:- 3rd Review, ready for corrections/issue Developer Inpact Fee
Planning Approval Called Contact Person A.I.P.P.
Pub. Wks. Appr Date of permit issue
School Fees
Total Permi Fees