08-1556 (RPL)P.O:-BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t!t 4 X�&Q"
Application Number:
08-00001556,
Property Address:
55882 BRAE BURN
APN:
775-280-063- - -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
25000
Applicant: Architect or Engineer
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty o perjury that I m lice ed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of t Business a d 'ovals Code; and my License is in full force and effect.
License C8 C27 C29 License No.: 656128
Date: '� Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of per y t t I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Bu rte and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolis 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 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 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
Owner:
ROBERGE
55882 BRAE BURN
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/16/08
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 andwill maintain rkers' compensation insurance, as required by Section 3700 of the Labor
Code, for the perform ce of the 4rk for which this permit is issue My workers' compensation
insurance carrier and p )icy numbeAre:
Carrier SEABRIGHT Policy Number BB10805
I certify that, in the performs a of the work for 'ch f !pis per is issued, I shall not employ any
person in any manner so as t eco e c o t w e ompensation laws of California,
and agree that, if I should becom lect - er mpensation provisions of Section
3700 of the Labor Code, I shal rt y w' hose provisions.
Date: -- _ Applicant:
WARNING: FAILURE TO SECURE V(ORK§RS' OMPENSATION COV-ERA6 UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIM PE LTIES AND CIVIL FINES UP TO 0 NDRED THOUSAND
DOLLARS ($100,000). IN ADDITIO T HE COST OF COMPENSATION, DAMAGES PROVIDED FOR IN
SECTION 3706 OF THE LABOR C D NTEREST, 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 r
2. Any permit issued as a result of this applicatio beco es null and void if wor is not commenced
within 180 days from date of issuance of suc&permiA ork for days will subject
permit to cancellation.
I certify that I have read this application and state that the abov 'n Soa
correc Iagreeto comply with all
city and county ordinances and state laws relating to building con ,and thorize representatives
of thisy)gptyY�enter upon the above-mentioned property for ' sp r o
Signature (Applicant or Agent):
Application Number . . 08-00001556
Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 3/15/09
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE >100K 11.00
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Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 252.00 Plan Check Fee 163.80
Issue Date . . . . Valuation . . . . 25000
Expiration Date 3/15/09
Qty Unit Charge Per Extension
BASE FEE 45.00
23.00 9.0000 THOU BLDG 2,001-25,000 207.00
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Permit . . . ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 45'.00 Plan Check Fee 11.25
Issue Date . . . . Valuation . . . . 0
Expiration Date 3/15/09
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
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Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 33.00 Plan Check Fee 8.25
Issue Date. Valuation . . . . 0
Expiration Date 3/15/09
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 3.0.0
-
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Special Notes and Comments
POOL/SPA, BBQ. ALARMS/BARRIERS SHALL BE
LQPERMIT
Application Number . . . . . 08-00001556
Special Notes and Comments
IN PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. FOR
BBQ L.F. " GAS LINE
- - Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 356.00 .00 .00 356.00
Plan Check Total 189.80 .00 .00 189:80
Grand Total 545.80 .00 .00 545.80
LQPERMIT
Bin #
City of. La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: �N
Owner's Name:
A. P. Number:
Address:c?jjR
Legal Description:
City, ST, Zip: U�(itGYL
Contractor:e
Address:b— ��
Telephone:
Project Description: L,
City, ST,
Telephone:
State Lic. # : 2
CityLic. #:�
yc,
Arch., Engr., Designer:
Address:
/ /G<� 4f •
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
GfG��LIZ
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: T# Units:
1
Telephone # of Contact Person:(7(o0 0-- CMZ g 1
Estimated Value of Project: 2-0— 2.5 <
APPLICANT: DO NOT WRITE BELOW THIS LINE
N Submittal Req'd Rec'd TRACING. PERMU FEES
Plan Sets Plan Check submitted
-T
Item Amount
Structural Calcs. Reviewed, ready for corrections 1 Plan Check Deposit
Truss Calcs. Called Contact Person Plan* Check Balance
Energy Calcs. Plans picked up Construction
Flood plain plan Plans resubmitted Mechanical
Grading plan' 2"° Review, ready for corrections1issue Electrical
Subcontactor List Called Contact Person Plumbing
r_,.__ . _...._^ -_ . anl—s resu6miff —Mt7rain
l lI Pub. Wks. Appr I l l Date of permit issue
{ School Fees I
Total Permit Fees