07-3100 (RPL)- P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00003100__
Property Address: 81925 RUSTIC CANYON DR
` APN: 764-280-999-55 -30023.7-
Application description: POOL - RESIDENTIAL
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 25000
T4*hf . 4144�rw
Architect or Engineer: .
olQ
BUILDING &SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
THOMAS
81925 RUSTIC CANYON DRIVE
LA QUINTA, CA 92253
------ ----- ------------- -----------------------t_""
LICENSED CONTRACTOR'S. DECLARATION
I hereby affirm under penalty of perjury that am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business nd Professionals Code, and my License is in full force and effect.
License a �C8 C27 C29 License No.: 656128
ate: C ractor
OWNER -BUILDER DECLARATION
1 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 _ I 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 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.).
( 1 1 am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby, affirmunder 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/07/07
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 Section3700of the Labor Code, for the performance of the work for which this permit is
-9issued.
1have 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 JI
cy Number BB1070510
I certify that, in the performancwork for which this permit is issued, I shall not employ any
person in any manner so as tme subject to the workers' compensation laws of California,
and agree that, if I shout ubject to the workers' compensation provisions of Section
3700 of the labor Cod , I hhwith comply with tho provisions.
a0D te: L dplicant:
WARNING: FAILURE TO SECURE W PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. 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 info ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building constr ion, and hereby authorize representatives
'of this co yto enter up the above-mentioned property inspe ion purposes.
ate: d Signature (Applicant or Agent):
Contractor:
t7
TESERRA
P.O. BOX 1280
�y
COACHELLA, CA 92236
G
(760)398-9222
Lic. No.: 656128
------ ----- ------------- -----------------------t_""
LICENSED CONTRACTOR'S. DECLARATION
I hereby affirm under penalty of perjury that am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business nd Professionals Code, and my License is in full force and effect.
License a �C8 C27 C29 License No.: 656128
ate: C ractor
OWNER -BUILDER DECLARATION
1 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 _ I 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 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.).
( 1 1 am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby, affirmunder 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/07/07
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 Section3700of the Labor Code, for the performance of the work for which this permit is
-9issued.
1have 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 JI
cy Number BB1070510
I certify that, in the performancwork for which this permit is issued, I shall not employ any
person in any manner so as tme subject to the workers' compensation laws of California,
and agree that, if I shout ubject to the workers' compensation provisions of Section
3700 of the labor Cod , I hhwith comply with tho provisions.
a0D te: L dplicant:
WARNING: FAILURE TO SECURE W PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. 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 info ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building constr ion, and hereby authorize representatives
'of this co yto enter up the above-mentioned property inspe ion purposes.
ate: d Signature (Applicant or Agent):
�.. Application Number .
. . . . 07-00003100
Permit
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
252.00 Plan Check Fee
.163.80
Issue Date . . .
Valuation . . .
. 25000
Expiration Date
6/04/08
Qty Unit Charge
Per
Extension
BASE FEE
45.00
3.00 9.0000
----------------------------------------------------------------------------
THOU RTT)C 2..001-29..600
2n7 0Ll
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation
0
Expiration Date
6/04/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
----------------------------------------------------------------------------
EA MECH FURNACE >100K
11.00
-----Permit'
Permit .. . . . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
6/04/08
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
6/04/08
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 '
. ----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS.SHALL
BE IN
LQPERMIT ..
r
" Application Number . . 07-00003100
.
Special Notes and.Comments
PLACE AT PRE -..PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged
Paid
Credited
Due „
- -----------------
Permit Fee Total 356.00
.00
.00
356.00
Plan Check.Total 189.80
.00
.00
189.80
Grand Total 545.80
.00
.00
545.80
LQPERMIT
..
Bin#
Permit # n
%
Project Address: ..
A. P. Number:
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
A Owner's Name:S
Address:
Legal Description:
City, ST, Zip:
Contractor: —�
Pup
Tele hone:
Address:
0
Project Description:
City, ST, Zip: 6�,,,t . IAL Ct�, zz-� "
i>0 L s
Telephone:
,
State Lic. # : 65
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:��
,� �
Construction Type: Occupancy:
State Lic.
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: " <j(
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: Q51000
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
r Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cales.
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
tN HOUSE:-
"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A_t.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
SCALE DATE DRAWN BY SOLD BY CHEC ...- BY
A
STONE
TILE
BOULDERS
DECK COLORI
DANDY
o
PEBB./PLAStt.SLia
FJ.,
SIGNATURE
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0
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