05-5280 (RPL)P:O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tiht 4 XP Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 05-00005280
Property Address: 433 -28 -BORDEAUX DR
APN: 609-380-997-62 -293233-
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 20000
Applicant:
I hereby affiry� under penalty of perjury
Section 700p1 of Division 3 of the Busi�
Licensaii s:_1C5d-
Architect or Engineer:
�Ir
IED CONTRACTOR'S DECLARATION
l,�sed under provisions of Chapter 9 (commencing with
rofessionals Code, and my License is in full force and effect.
License No.: 658996
Date Co ctor: t
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury the 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 (lie
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.).
I _ 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
Owner:
DEMARCO RALPH & JOSEPHINE
43328 BORDEAUX DRIVE
LA QUINTA, CA 92253.
Contractor:
FAMILY POOL CONSTRUCTION
P O BOX 283
LA QUINTA, CA 92247
(760)564-3655
Lic. No.: 658996
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/01/05
L5 2005
A QUINTA
E DEPT.
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 nu er are:
Carrier STATE FUND IicyNumber 1344032-2005
I certify that, in the performanc of t e work for which this permit is issued, I shall not employ any
person in any manner so as o be me subject to the workers' compensation laws of California,
and agree that, if I should am subject to the workers' compensation provisions of Section
37 of the Labor Cod nhwith comply with those provisions.
e icant:
WARNING: FAILURE TO SECURE WORK F
SUBJECT AN EMPLOYER TO CRIMINAL' E
DOLLARS (0100,000). IN /ADDITION TO
SECTION 3706 OF THE LABOR CODE, I T
' COMF)ENSATION COVERAGE IS UNLAWFUL, AND SHALL
ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
E DOST QF r.nMPFNSATION. DAMAGES AS PRQVIDED FOR IN
TEST, 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 personuponwhose 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 issuanceof this perm'q
2. Any permit issued as a result of this application be Les null . work is not commenced
within 180 days from date of issuance of such pe cessation of work for 180 days will subject
permit to cancellation.
I certify that have read this application and state that thea 'nformation is correct. I agree to comply with all
city and courFy cFdiqpKces and state laws relating to buil s ction, and hereby authorize representatives
of tl, ilAckinfer upon the-abbve-mentioned propel4%for i GFt urposes.
(Applicant or Agent):
Application Number . . . . . 05-00005280
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
207.00
Plan Check Fee
134.55
Issue" Date . . . .
Valuation . . .
. 200.00
Expiration Date
5/30/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000•
162.00
Permit
MECH POOL
Additional desc .
Permit Fee . . . .
26.00
Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
5/30/06
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
5/30/06
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
5/30/06
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 . . . . . 05-00005280.
----------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
.EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited Due
------------------------------------------------------
Permit Fee Total 311.00 .00 .00 311.00
Plan Check Total. 160.55 ..00 .00 160.55
Grand Total 471.55 .00 .00 471:55
LQPERMIT
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRUCTION
DATEA•4'0 BY
A RE -INSPECTION FEE OF
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDU ON
INSPECTION. LED
NO EXCEPTIONS!
Construction
Pools Spas 1ounlaln5
C7�0>5G4-3655
Lic, #658996
Bin #
City Of La Quinia
Building 8r Safety Dlvislon
P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
BL Tiding Permit Application and Tracking Sheet Gicc o
Permit #
Project Address: a ��jV
Owner's Name:
A. P. Number:
Address: 3 3 Z EAM-.,i4
Legal Description:
City, ST, Zip: N
Contractor: - s
Telephone:
Address: M®t F96V pg5
Project Description: (DOL S
City, ST, Zip: ZA(ktA/ h'i['•
Telephone:
State Lic. # : City Lic. C
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
_ � ��-�t ''� 's '
.:�;•.�.. :
Construction Type: Occupancy:
Project type (circle one) New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
nn TT
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
it
Submitral
Req'd
Reed
TRACKING
PERMTT FEES
Plan Sets
Plan Check submitted
Item
Amount
St mctural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Tress Calcs.
Called Contact Person
Plan Check Balance
Intle 20 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2T'! Review, ready for correctionstiissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:gi
k' 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
Total Permit Fees