09-0473 (PLBG)% 4
P.O. BOX 1504 '
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00000473
Property Address: 43439 BORDEAUX DR
APN: 609-380-997-51 -293233-
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 500
Applicant:
0ti 1A4 -1_61L_
C
T`h
t44Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MAZZULLA RESIDENCE
43439 BORDEUX DRIVE
LA QUINTA, CA 92253
Contractor:
Architect or Engineer:, FAMILY POOLS CONSTRUCTION
�( Z� P O BOX 283
LA QUINTA, CA 92247
(760)564-3655
Lic. No.: 658996
IC D CONTRACTOR'S DECLARATION
under penalty of perjury t a licensed under provisions of Chapter 9 (commencing with
of Division 3 of the Bus' � Professionals Code, and my License is in full force and effect.
C53License No.: 658996
Contractor: "
t \ jOWNER-BUILDER DECLARATION
I here y affirm under penalty of perjury that �'T�'�,�f" exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and fessions 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 ($5001.:
1 _ 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 (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 contractorls) 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
/ Date: 5/13/09
�,r •�` �d �6f
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 STATE 'FUND Policy Number 1344032-2009
I certify that, in the performance of the ork for which this permit is issued, I shall not employ any
person in any manner so as to bec subje the workers' compensation laws of California,
*FLURE
ee that, if I should becoKiehe workers' compensation provisions of Section
f the Labor Code, I shaply with those provisions.
CDate.pplicaott
WARNO SECURE WORKERS' C PENSA N COVERAGE IS UNLAWFUL, AND SHALL
SUBJER TO CRIMINAL PENALTJqS AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE CMT 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 omes n void if work is not commenced
within 180 days from date of issuance of suc p , or
, or cef work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state th0hebinformation is correct. I agree to comply with all
city and c my o inances and state laws relating tstruction, and hereby authorize representatives
of this ty t r upon the above-mentioned prpecti n purposes.
Date: ignature (Applicant or Agent):
A
LQPERMIT
Application Number . . . . . 09-00000473
Permit . .
. PLUMBING
Additional desc .
Permit Fee . . .
. 18.00
Plan Check
Fee
4.50
Issue Date . . .
.
Valuation
. . .
. 0
Expiration Date .
. 11/09/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB WATER
INST/ALT/REP
3.00
----------------------------------------------------------------------------
Special Notes and
Comments
PARTIAL FUTURE SEWER LINE REFERENCE
PERMIT 09-312.
-----------------------------------------------------------------------------
Other Fees . . .
. . . .. . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid
--------------------
Credited
--------------------
Due ..
-----------------
Permit Fee Total
18.00
.00
.00
18.00
Plan Check Total
4.50
.00
.00
4.50
Other Fee Total
1.00
.00
.00
1.00
Grand Total
23.50
.00
.00
23.50
1
4" Pla
4-" .sewer Lime for
Fufure Ga54fa5
PEPPY l" /VZULLft
43439 Poeorttux DP/VF
TAPF.STPf/FSPl-ANAOF - I -A OUINrA
GODF KEY KEY II6I
,9�a/rmd/ V� 5D-&c�&
Construction
P00I5 S j7a5 FOud aln5
C7�O��G� 355
Lic
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
. L���
Project Address: x
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: ,/ (� S'
Telephone f?wf:a:<r,:<,N;
..
Address:
Project Description:)�/�
City, ST, Zip: q2—Z417
Telephone:
P to ^ J
::>w:;<•;•:.;>•.,•: :<:<+,,;�:Y>
State Lie. # : �O
City Lie. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: <:;•<r>v€i: F`` % ;:>:'< fir`: <'•.=':>
,: ;::> is ><:+:. 'st% •: ;r.f•::.;>:.; : %<:=
State Lie. #:
Construction Type:. Occupancy:
Project a circle one • New Add'n Alter Repair Demo
Name of Contact Person:.
Sq. Ft.:
#. Stori # Units:
Telephone # of Contact Person: !3
Estimated Value of Project:
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets.
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsrissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`" Reyiew,.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
r
Total Permit Fees