05-2941 (RPL)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA,. CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 05=00002941-7 Owner:
Property Address: 43511 BORDEAUX DR ALTON, SHANNON
APN: 609-380-997-54 -293233.- 43-511 BORDEAUX DRIVE
Application description: POOL - RESIDENTIAL LA QUINTA, CA
Property Zoning: LOW DENSITY RESIDENTIAL LA QUINTA, CA 92253
Application valuation: 20000 n
D�1 Contractor:
Applicant: Architect or Engineer: D REMBRANDT POOLS & SPAS
WCC: STATE FUND
1
UL { 8 2005 WC: 1744664
a_,Q� _ CITyOF CSLB: 800680
,v Il v`' C I o FINeu � QUINTA
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 Cla s: License No,: e /
Contract
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 IS500).:
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 _ 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 ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERI%IIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/15/05
INC
10/01/05
11/30/06
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 C53 Policy Number - - - - - - - - - - - - - - -
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
37 0 of the Labor Cod s forthwit - ompl with those provisi s.
tr `S
Date: �O ®J4pplicant: .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGIIaUNLAWFUL, 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.
certify that 1 have read this application and state that the above ' ormation is correct. I agree t omply with all
city and county ordinances and state laws relating to building nstruction, and hereby authoriz presentatives
of thi/s c%�'my to ter Ron the above-mentioned prop rty inspection purpos s
Datfs: C/ 1SSignature (Applicant or Agent): `'�CA /I
Application Number . . . . . 05-00002941
.Permit . . . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
198.00 Plan Check
Fee
128.70
Issue Date . . . .
Valuation
. . .
. 18720
Expiration Date . .
1/11/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00•
17.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
153.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check
Fee
6.50
Issue Date
Valuation
. . .
. 0
Expiration Date .
1/11/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
------------------------L---------------------------------------------------
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-.
1/11/06
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
1/11/06
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
Permit . . . . .. . WALL/FENCE PERMIT
LQPEn11T
Application Number . . . . . 05-00002941
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 31.00 Plan Check
Fee
.00
Issue Date Valuation
. . .
. 1280
Expiration Date 1/11/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
8.00 2.0000 HND BLDG 501-2,000
16.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL & SPA ONLY.80 L.F. 3' GARDEN WALL,
CITY STANDARD. ALARMS/BARRIERS SHALL BE
IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid Credited
Due
----------------- ---------- ----- - ---- ----------
Permit Fee Total 333.00 .00
----------
.00
333.00
Plan Check Total 154.70 .00
.00
154.70
Grand Total 487.70 .00
.00
487.70
LQPERMIT
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B11i #
City of La Quinta
Building 8 Safety Division
P.O. Box 1504, 78-495 Cape Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Petmic
0 5-.2
Project Address:' / -u
Owner's Name: S I*Al Q NJ
A. P. Number 1'fP0 i 1° L1 WZW rS Off'
Address: v�
Legal Descripti • ' �a WY47e-1 AJ (�
City. ST. Trp:
Contractor. eOn MeAA)D 1 t SPA
FTclephone:
,�.jyL�
Address '� 8� / 0 v� �} (% �t/ / i i �v��
IVPmjcct Description: I'�i
City, ST, Zip:
Telephonc: 0 - -7-71217-1
ai74 (i /� Lel.
State Lic. # : o o & C S� City Lie. #:
Arch., Engr.. Designer.
W A,�— —x3'6'' y%
Address.
City, ST. Zip:
i3G! G! T o Z b,5
Telephone:�:.:�:,-^
Telephone -
-
Construction Type: Occupancy:
State Lie. #:
Project "(circle one): New Add'n Alter Repair Demo
Name of Contact Person: R UC -A S / ► tK J Jct'
Sq. FL:
#Stories:
# Units:
Telephone # of Contac Person: C 341-
imatcd Value of Project: 7/0 Z7U�
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Structural Cales.
Reviewed. ready for corrections
Plan Cbeck Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Encrgy Celts.
Plates picked up
Construction
Flood plain plan
Plans resubmitted
1lfec1128ical
Grading plan
V Review. ready for correctionsfi sue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A-Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for correctionsfissoe
Developer impact Fee
Planning Approval
Called Contact Person
A.i.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fens
1280
Ig qZ-o