13-1688 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
�i'CrLA�t11�1�L
13-00001688
48392 BIG HORN DR
623-480-004- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
28800
Tay/
4a"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
• k
Owner:
SALO, ROBERT A
Contractor:
DESERT OUTDOORS INC
78065 MAIN ST STE #205
LA QUINTA, CA 92253
(760)399-9600
Lic. No.: 964474
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/03/14
D°
JAN D 6 2014
CITY OF LA QUINTA.
FINANCE DEPT.
--------------------------------------------------------------
UCEN CONTRACTOR'S DECLARATION
7-----------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I a Ii ns nder 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 and r fe i als 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 Class: C27-053 License No.: 964474
_
r by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: I l'C _\ - Contractor:
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
WNER-BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of pe'ury that I a exempt from the Contractor's State License Law for the
Carrier AMTRUST INS CO Policy Number WWC3072369
following reason (Sec. 7031 .5, Busi ess and P ofessions Code: Any city or county that requires a permit to
_ 1 certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, o epair y structure, prior to its issuance, also requires the applicant for the
person in any manner so as come subject to the workers' compensation laws of California,
permit to file a signed statement that he a is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should b co esu ' ct 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 Code, I ha fort ith 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
I.
(_ I
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: I ' \ Applicant:
(_ 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
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 ISec.
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.).
I—) 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:
LQPERMIT
WARNING: FAILURE TO SE1"CODEONTEREST,
E WORK RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TOI MINAL)PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001• IN ATION THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LAB AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is her ade 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 Ouinta, 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 abov i ormatio orrect. I agree to comply with all
city and county ordinances and state laws relating to building c ns ructio , a hereby authorize representatives
of this county to enter upon the above-mentioned propert ecti pu oses.
'
Date: I `e I 1 Signature (Applicant or Agem), t
IN
Application Number . . . 13-00001688
Permit . . . POOL 2013
Additional desc .
Permit Fee . . . . 178.75 Plan Check
Fee
.00
Issue Date . . . . Valuation
0
Expiration Date . . 7/02/14
Qty Unit Charge Per
Extension
1.00 .178.7500 EA MISC POOL/SPA
178.75
-----------7----------------------------------------------------------------
Special Notes and Comments
.
POOL AND SPA AT REAR YARD (DENISE
POELTLER ENGINEERING] THIS PERMIT DOES
NOT INCLUDE EQUIPMENT ENCLOSURE. ALARMS
AND BARRIERS REQUIRED TO BE INSTALLED AT
PRE -PLASTER INSPECTION. 2010 CALIFORNIA
BUILDING CODE.
January 3,.2014 8:.48:29 AM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
2.00
PLAN CHECK, POOL
97.24
Fee summary Charged Paid Credited
-------------------------------------
Due
--------------------
Permit Fee Total 178.75 .00
.00
178.75
' Plan Check Total .00 .00
.00
.00
Other Fee Total 99.24 .00
.00
99.24
Grand Total 277.99 .00
.00
277.99
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 #
M-11011,
3 • I�D��
Project Address: l 4
Owner's Name:
A. P. Number.
Address:
Legal Description:
City, ST, Zip: V t
Telephone
Project Description: 03t,.
Contractor: �� `� Q
Address: ��(fl5 5
City, ST, Zip: L A U
Telephone .'� LpQj
k.
State Lia #: 9
City Lia 9,
Arch., F,ngr., Designer. �
Address:
City, ST, Zap:
Telephone: z Construction Type:. Occupancy:
State Lia #: 5 LfT e) Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. Ft: # Stories: # Units:
Telephone # of Contact Person: 27 C5 7j`j Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd TRACKING PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Structural Cates.
Reviewed, ready for correcdions
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain pian
Plans resubmitted
Mechanical
Grading plan
211 Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
1id Review, ready for correedoA A
Developer Impact Fee
Planning Approval
Called Contact Person !a
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees zi•%.gQ
1�v� 'to ISt�' ••