10-0307 (RPL)....... t
P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000307\,
Property Address:
54220 AVENIDA,RAMIREZ
APN:
774-212-011-14 -000000-
Application description:
POOL - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
14000
Applicant;,. ✓a:/`'" Architect or Erigineer:
I r,
4.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CONYERS
54220 AVENIDA RAMIREZ*
LA QUINTA, CA 92253
Contractor:, '
A 1. POOL CONCEPT
P.O. BOX 623
LA QUINTA„ CA 92253
(760)771=9822:
tic. No."746662
VOICE (760) 777=7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Aic�1 � 24
Date: 4/15/10
--------------------=`---------------=-------------------------"---------------------------=1---
LICENSED CONTRACTOR'S DECLARATION - .WORKgR'S.COMPENSATION DECLARATION '
I hereby.affirm under..penalty of perjury that) am licensed under, provisions of:Chapter 9 (commencing with I hereby affirm under penalty of perjury one of. the following declarations: •. .
Section 7000).of.Divis`ion 3 of the Business and Professionals Code, and my rise is in fullforceand effect. _ I have and will maintain a certificate; of consent,to self -insure for workers' compensation, as provided
Cicens s's. C12' 053. cense No.: 7 6 62 for by Section 3700 of the Labor Code for the performance of the work for which.this, permit is
issued.. z .v> . _ 1
a Date: Co cto : - NW.- I have and'will maintain workers' compensatiti on insurance,' as required by Section 3700 of, the Labor
...OWNER=BUILDER-DECLARATION
- I hereby affirm � dei: penalty of perjury. that I,am.exempt from the Contractor's State License Law fortfie,:
.following reason'.(Secm
: 7031 5;�Busess arid.Professions;CoderiAnycity or county that requires a.: permit to .
construct;•alter, improve demolish, or repair any structure ipriorto its issuance, also requires. the applicant for the
permitto�file a signed statement that he or she is.licensed pursuant to the provisions of the Contractor's State
License Lavi (Chapter 91i:ommencing*with Section 7000) of.Division3 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.(S500).:
1 ) I, as th
owner of e property; or rriy.employees.wn ith wages as thesole compensation, will do the.work,'a_nd
the structure isnot intended'oroffered for sale. (Sec. 7044 Business �and.Professions Code:. The .
Contractors' State.License.iaw does not'.apply toran owner of propeity who.builds or improves thereon,
'andjwho 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; th.e building.or improvement is, sold within
one year 'of completion; the owrner-builder will have the burden of,proving-that he or she did riot build or
rove;for the purpose of sal,e,L
;as ownerof-.the property,amexclusively. contractingjwith-licensed contractorsto constructthe'�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,:aWwho contracts for the'projects with a contractor(s) licensed
pursuant to the, Contractors', State License Law.).
(_ 1 I am exempt under Sec. 7B.&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: n/
Lender's Address: K
LQPERMIT
Code, for:.the. performance of. the work for; which this.permit.Is issued. My workers compensation
insurance carnerand policy number a.i •,• 0
Carrier STATE FUND:,` PolicyNumb'er •1576693-200,9
^+I certify that,`inthe'performance of the work for which-this.permitis issuedil'shall not employ any
'
person in. any manner'so as to become subject to the workers' •compensation laws oYCalifornia,
and agree that; if I-shouldbecome subject;to the workers' compe ion provisions of Section
,8700 of thvLabor cGoe, I shay[1_6 w, f'comply with those pr isi ns-
ate:ppIic4nt: ! -
o�
WARNING:F RE TO.SECURE' WORKERS' COMPENSATION COVERAGE IS UNL'AWFUL;:AND.SHALL
•
SUBJECT,A EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP,TO ONE HUNDRED THOUSAND
DOLLARS (5.100 000)` IN:ADDITION TO THE COST OF COMPENSATION, DAMAGES'AS PROVIDED FOR IN
SECTION 3,706 -OF THE LABOR CODE; INTEREST,.AND:ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby.madIa to theDirectorof Building,and Safety, for a permit subject to the
conditions and restrictions set forth or this application.
1. Each person upon whose behalf this application is'made, each person at whose request and for
whose benefit work isperformed under or pursuant to any permit issued as a result of, this application,
the owner, and the applicant, each agrees to, an_d 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 thafthe above information is correct. I agree to c ly With all
city and county ordinances d state laws relati�nt)
building construction, ereby author epr entatives
;a/le
co ty ..``enter up the above-mentiono or ins urp es.
: v ignature (Applicant or A
Application Number . . . . . 10-00000307
Permit BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 153.00 Plan Check Fee
99.45
Issue Date . . . . Valuation . . .
. 14000
Expiration Date 10/12/10
Qty 'Unit Charge Per.
Extension
BASE FEE
45.00
12.00 9.0000 THOU. BLDG 2,001-25,000
108.00.
" Permit ELEC POOL PERMIT -RES.
Additional desc;.. -
r- - Permit Fee . . . . 45..00 Plan. Check Fee
11.25
Issue Date Valuation . . .
. 0
Expiration Date 10/.12/10
Qty' Unit.Char ge Per
Extension
BASE FEE' -
15.,00
•1-.00 30.0000 EA ELEC PRI-VATE SWIMMING POOL
.30.00.
Permit PLUMBING
Additional desc
Permit Fee•27.00 Plan Check Fee"
6.7.5.
Issue Date- Valuation
0'
Expiration'�Date .. 10/12/•10
Qty Unit Charge.- Per -
Extension
,BASE
15.00 ..
._FEE
.. •• .�
`< 1.00 ` 6::00.0,0 EA PLB:.FIXT.URE
:6:00.
1_ 00 '3.0000 . EA PLB i4ATER INST/ALT/-REP
3.00
1.00 .3 .;0000 EA PLB' GAS. RIPE 1-4 OUTLETS
3'.'0.0
Special; Notes -and CoMment'S
POOL.. ALARMS/BARRIERS.SHALL BE IN '-PLACE
AT,.' PRE PLASTER;;INSPECTION. EQUIPMENT
ENCLOSURE- NOT INCLUDED".:2007 CODES.
----------- ----------- ------ ----------------------------
----- -------------------------------
Other-Fees BLDG STDS'ADMIN:'(SB1413)
dther-Fees
--------------
1.00
Fee:.sumnary; Charged ':" Paid Credited
Due
Permit Fee Total 225;:;0.0 _ .0.0 .00.
225.00
Plan Check - Total 117.45 .:00 .00
117.45
Other -Fee Total.. 1.00 .00 .00
1..00
Grand Total .343.45 .00 .00
343.45
LQPERMIT
•' �' �. Gate
--
CITY OF l.p`
OUINTA
BUILDING & SAFETY DEPT, PT.
APPROVED
FOR CO STRUCTiON
/� /,'
DAT " � IDgY
Conyers Residence
54220 Avenida Ramirez
ep La Quinta, CA 92253
L
•
(Block Walll
T
a � 129'6
O Block Wall
3'0 jPool Equip.
� Y
Propane Tank
12'0
Bin #
City of La ::Quints;
.= r ,
Building 8T Safety Division
P O Boz 1504; 78 495 Ca11e .Tampico
Permit #
O�
to Quirita, CA.92253 .(760) 7.7,7-476
Q '
Btuildin Permit Application and Tracking Sheet
Project Address: S7^ erl� fiLc z. ,
-Owner's Name: y
A. P. Number:
'Address: '�\ QQ
o� Py,[aC� I�H1 RCZ
Legal Description:
'City, ST,:Zi p:
Contractor:' Il
�J
'`Telephone:
vitae
•,.�i;rn�;:.:t:,?�•�>>.
Address:
'Project Description:
City, ST, Zip:��
SGC//Yl l
/77 a Oc9 Vit
Telephone:
:y jj�$YI`�•I;�''Si}�'•}i:0�h:/".').;.!;:ice?Y•4::: ::
State Lic. #: C W•
City Lic #:
Arch., Engr., Designer:
Address:
L
City., ST, Zip:
-..
'
'
Telephone:
� ♦ f C'` ..Y�.:.:.yj to
: .. _
Constructton Type Occupancy:
State Lic. #:`.,Project
type (circle one): e ) Add'n Alter Repair Demo
°Sq: Ft.: # Stones: # Units:
Name of Contact Person:
Telephone #'of Contact Person:" - p- . A,
Estimated Value of Project.. OQ(�
• APP,LICANT. DU'NOT•WRITE BELOW THIS LINE '
#
Submittal
Re
Recd
TRACKING "
PERMIT FEES
Pian Sets
k..;Plan
Check submitted '
item,
Amount
Structural Calcs.
Reviewed,_ ready for corrections
i'Ian:Check Deposit
Truss Calcs.
Called Contict:Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up x"
Construction
Flood plain plan
Plans,resubmittedg
-Mechanical
Grading�plan
2°" Review, ready forrcorrectionstissue
Electrical
Subcoatactor List
Called Contact Person
Plumbing
Grant Deed
Plans. picked up •'.
H.O.A: Approval
Plans resubmitted �. ,
Grading
IN HOUSE:-
''" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called ContactPerson
Pub. Wks. Appr
Date of permff issue
School Fees
Total Permit Fees