10-0820 (RPL)4
T4ht
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/01/10
Application Number: 10-00000820 Owner:
Property Address: 45210 BIRCHCREST CIR CHRISTENSEN
APN: 604-412-015-24 -23995 - 45-210 BIRCHCREST
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 22000 D 0
JT
Contractor:
Applicant: Architect or Engineer: MCRAE POOL" & SPAS
SEP 0 2 2010
79105 DESERT STREAM
LA QUINTA, CA 92253
I� F LA QUINTA
(760)772-2440 G�TMANCE
FiA?`��DEPT.
R
(/ Lic. No.: 823017
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
license Class: .C53 -C27 License No.: 823017
ate:+/ s onuactor: G
OWNER -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, 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 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
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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.
1 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 STATE FUND Policy Number 1950505
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of thktabor Code, I shall forthwith com I w' ose provisions.
ate: �` b PPI
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned propexf'ction purposes.
ate( gnature (Applicant or Agent):
Application Number . . . . . 10-00000820
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee 225.00 Plan Check Fee 146.25
Issue Date . . . . Valuation . . . . 22'000
Expiration Date 2/28/11
Qty Unit Charge Per Extension
BASE FEE 45.00
20.00 9.0000 THOU BLDG 2,001-25,000 180.00
---------------------'------------------------------------------------------
Permit . . . MECH POOL
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . 0
Expiration Date 2/28/11
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 2/28/11 .
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 2/28/11
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 . . . . . 10-00000820
----------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. 2007
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged Paid Credited Due
Permit Fee Total 329.00 .00 .00 329..00
Plan Check Total 172.25 .00 .00 172.25
Other Fee Total 1.00 .00 .00 1.00
Grand Total 502.25 .00 .00 502.25
LQPERMIT
Bin #
Permit # Q
Project Address: 4S --2,1r
A. P. Number:
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Cape Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:
Address:
Legal Description:
City, ST, Zip: r,/W
Contractor: At
0
Telephoner s> '<vrf ; <,y
Address: _
J11
Project Description: CIO ar
City, ST; Zip:
.22
Telephone:
: ',, # >:•{{° : r
State Lic. # : Q322jo?
CityLic. C.
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:,
State Lic. #:
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�.,;.:, , ,,,� • ;. y�zv, ...��,�,
Construction Type: Occupancy:
Project type (circle one): New Add.. n Alter Repair Demo
Ft : #Stories: # Units:
Name of Contact Person:Sq:
Telephone # of Contact Person:
y- C3 Estimated Value of Project:.
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACING
PERMIT FEES
Plan Sets
Plan Check submitted;
f 0
Its. Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales•
Called Contact Person
Plan Check Balance.
Title 24 Cales.
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:-
'a Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Ll
i
I
Total Permit Fees
I
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DRAWN
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CHECKED
DATE
SCALE
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SHEET
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