07-2741 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
07-00002741
Broperty-Address:
—8394-0—RUSTIC CANYON DR
APN:
764-280-999-68 -300237-
Application description:
POOL - RESIDENTIAL .
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
25000
Applicant:
Architect or Engineer:
l
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury. that I m licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business an Professionals Code, and my License is in full force and effect.
License Class: C8 C27 C29 License No.: 656128
(Date, l - ^onvacto?
NER-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 _ 1 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
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 .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.).
Lender's Name: _
Lender's Address:
LQPERA11T
Owner:
SALUTE RESIDE:
81-940 RUSTIC
LA QUINTA, CA
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA
(760)398-9222
Lic. No.: 656:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/11/07
------------------
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 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 t e work for which this permit is issued, I shall not employ any
person in any manner so as to be me subject to the workers' compensation laws of California,
and agree that, if I shou become ubject to the workers' compensation provisions of Section
3,700 of the Labor C hwith comply with those. provisions.
WARNING: FAILURE TO SECURE WOFjJ�!`IPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES'AND CIVIL FINES UP TO 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 abokinection
mation is correct. I agree to comply with all
city and county ordinances and state laws relating to buil n tion, and hereby authorize representatives
of this cou ty to nter upon the above-mentioned prop y f r purposes.
Date , ignature (Applicant or Agent):- - a _
: Application Number .
. . . . 07-00002741
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee
252.00 Plan Check
Fee
163.80
Issue Date . .-
Valuation
. . .'.
25000
Expiration Date
4/08/08
Qty 'Unit Charge
Per
Extension
BASE FEE
45.00
23.00 - 9".0000
THOU BLDG 2;001-25;000
Permit
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check
Fee..
6.50
Issue Date
Valuation
. . .
0
Expiration Date '.
4/08/08
Qty Unit Charge
Per
Extension
BASE FEE
_
15.00
1.00 11.000.0
EA MECH FURNACE >100K
11..00
Permit I. . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee. . . . .
45.00 Plan Check
Fee
11.25
Issue Date . . . .
Valuation
. . . .
0
Expiration Date
4/08/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
EA ELEC PRIVATE SWIMMING
POOL
-30.00
PermitPLUMBING
Additional desc .
Permit Fee . .
.33.00 Plan Check
Fee
8.25
..Issue Date.
Valuation
. . . .
0
Expiration Date
4/08/08 .
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
.
Application Number . . . . . 07-00002741
----------------------------------------------------------
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
r
.
LQPERMIT
Bin #
Permit
Project Address: 91— Vqo
A. P. Number:
Legal Description:
Contractor:
Address:
City, ST, Zip: &n
Telephone:
State Lic. #
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
M I Submittal
Plan Sets
Structural Cafes.
Truss Cafes,
Energy CaIcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
R.O.A. Approval
IN IdOUSE:-
Planning Approval
Pub. Wks, Appr
School Fees
City ®f La Quints
Building 8L Safety Division
P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet-
L)
heen
tTDR OA) Name;
L
Zip:e:escription:
Lic. #: ..
Construction Type: Occupancy:
M Project type (circleone)• New Add n Alter Repair Demo
�- Sq. Ft.; # Stories: # Units:
Estimated Value o.f Projec
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rec'd TRACKING
Plan Check submitted
Reviewed, ready for corrections
Called Contact Person
Plans picked up
Plans resubmitted
2nd Review, ready for correctionsrissue
Called Contact Person
Plans picked up
Plans resubmitted
3rd Review, ready for corrections/issue
Called Contact Person
Date of permit issue
PEl AIRT FEES
Item Amount
Plan Check Deposit
Plan Check )Balance
Constructi :)n
Mechanical
Electrical
Plumbing
S.M.I.
Grading
Developer Impact Fee
A.I.P.P.
Total Perrlit Fees