14-0708 (RPL)T4ht 4
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: 6/04/14
Application Number: 14-00000708 Owner:
Property Address: 78985 CALLE BRISA SARETSKY RESID
APN: 649-450-039- - - 78985 CALLE BR F
Application description: POOL - RESIDENTIAL LA QUINTA, CA 2 3 7u -
Property Zoning: LOW DENSITY RESIDENTIAL JUNApplication valuation: 35000
irc OF I.A
Contractor.r-l-NA•' CE Br¢T.
Applicant: Architect or Engineer: TESERRA
P.O. BOX 1280
COACHELLA, CA 92236.
(760)39
�v4r Lic. No..:: 656 656128
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.
Licenseclass: C8,10,27,2 LicensseeeNNo.: 65661228.,
Date: 6 J Contractor:
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, 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.).
(_) 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
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 EVEREST NATL IN' Policy Number 7600006481141
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 the Labor Code, I shall forthwith,, comply with those provisions.
Date:fo S Applicant:�/%/J.O�.f�
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 property
for inspection purposes.
Date:(D 57 141 Signature (Applicant or Agent):
Application Number . . . . . 14-00000708
Permit . . .
POOL 2013
Additional desc . .
Permit Fee . . . .
178.75 Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date
12/01/14
Qty Unit Charge
Per
Extension
1.00 178.7500
----------------------------------------------------------------------------
EA MISC POOL/SPA
178.75
Permit . . .
ELECTRICAL 2013
Additional desc . .
BBQ
Permit Fee . . . .
23.83 Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
12/01/14
Qty Unit Charge
Per
Extension
1.00 23.8300
----------------------------------------------------------------------------
LS ELEC.DEVICES, FIRST 20
23.83
Permit . . .
PLUMBING 2013
Additional desc . .
BBQ AND FIRE PIT_
Permit Fee . .
11.92 Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
12/01/14
Qty Unit Charge
Per
Extension
1.00 11.9200
----------------------------------------------------------------------------
LS PLBG GAS SYS, 1-4 OUTLETS
11.92
Permit . . .
WALL/FENCE PERMIT 2013
Additional desc .
Permit Fee . . . .
47.19 Plan Check Fee
00
Issue Date . . . .
Valuation . . . .
35000
Expiration Date
12/01/14
Qty Unit Charge
Per
Extension
1.00 47.1900
LS MISC WALL, FIRST 100 LF
47.19
----------------------------------------------------------------------------
Special Notes and Comments
-
POOL, SPA, FIRE PIT,
BBQ AND EQUIPMENT
WALL AT REAR YARD [DOUGLAS FERRELL
ENGINEERING] THIS PERMIT DOES NOT
INCLUDE PATIO COVERS.
ALARMS AND
BARRIERS REQUIRED TO
BE INSTALLED AT
PRE -PLASTER INSPECTION. 2013 CALIFORNIA
BUILDING CODES.
LQPERMIT �'
Application Number
. . . . .
14-00000708
----------------------------------------------------------------------------
Special Notes and
Comments
June 4, 2014 4:17:44
PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . .
. . . . .
BLDG
STDS ADMIN (SB1473)
2.00
PLAN
CHECK,.ELECTRICAL
23.83
PLAN
CHECK,
POOL
97.24
PLAN
CHECK,
PLUMBING
23.83
PLAN
CHECK,
WALLS
60.06
Fee summary
-----------------
Charged
----------
Paid
----------
Credited
--------------------
Due
Permit Fee Total
261.69
.00
.00
261.69
Plan Check Total
.00
.00
.00
.00
Other Fee Total
206.96
.00
.00
206.96
Grand Total
468.65
.00
.00
468.65
LQPERMIT
Iain #
City ®f 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 #
0
Project Address: !s
Owner's Name:
A. P. Number:
Address: � //Y p119,11
Legal Description:
City, ST, Zip: A 49
Contractor: �C..,S'�iC �/7
Telephone:
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Address: ®(' �� s/�T
Project Description:W/-J VIAO � 0-w.....
City, ST, Zip:dad.,eC
l
el
T e hone: .2
P 1
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State Lic. # :
City Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
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...........:.... ......................................
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: O ��
Sq. Ft.: 5e--#
Stories:
Units:
Telephone # of Contact Person: s S %�Q33
�,y#�
Estimated Value of Project: 3 66:25 '
APPLICANT: DO NOT WRITE BELOW THIS LINE
11
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted j
Item
Amount
Structural Calcs,
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:-
'"' Review, ready for correctionissu
eveloptr Impact Fee
Planning Approval
Called Contact Person,
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Paym l U �s
.... ......::..
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