07-1042 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4tyl
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
-:', 07-00001042
Property Address:
81776 CONTENTO
APN:
767-200-011-6 -318742-
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
20000
Applicant:
Architect or Engineer:
-
----------- - - - - --- -- ---------------------------
LI r D CONTRACTOR'S DECLARATION
I hereby aff m u der penalty of perjury th m licensed under provisions of Chapter 9 (commencing with
Section b 0) Division 3 of the Bu' s Professionals Code, and my License is in full force and effect.
Licens C 5 License No.: 658996
Date: D Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and P 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 ofnot more than five hundred dollars 155001.:
(_ 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 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
4/05/07
Owner:
FAULKNER RESIDENC
81-776 CONTENTO
LA QUINTA, CA 922
Contractor:
FAMILY POOLS CONST
P O BOX 283
LA QUINTA, CA 92247
(760)564-3655
Lic. No.: 658996
-c 1
APR 05
2007 D j
------------------
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 he work for which t is permit is issued. My workers' compensation
insurance carrier and policy mber are:
Carrier STATE FUND F I Policyer 1344032-06
_ I certify that, in the performanc o the ork for which this permit is issued, I shall not employ any
person in any manner so as t ome subject to the workers' compensation laws of California,
1 I ' and agree that, if I shout subject to the workers' compensation provisions of Section
,x3700 of the Labor Co e, I I ort comply with those provisions.
WARNITG: I FAILURE TO SECURE. WORKERS' VqMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENAL ES 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 :permit.
2. Any permit issued as a result of this appli ti becomes and void if, work is not commenced
within 180 days from date of issuance o su h pe , or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state a bove information is correct. I agree to comply with all
city a co ty ordinances and state laws rel g t b ng construction, and hereby authorize representatives
of this enter upon the above-ment p for insp tion purposes.
Date:' Signature (�Applican�t'or"Agent)
N
LQPERMIT
Application Number . . . . . 07-00001042
Permit
. . . MECH POOL
Additional
desc .
Permit Fee
. . . . 26.00 Plan Check
Fee
6.50
Issue Date
. . . . Valuation
. . .
. 0
Expiration
Date 10/02/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00
----------------------------------------------------------------------------
11.0000 EA MECH FURNACE >100K
11.00
Permit
. . . BLDG POOL PERMIT
Additional
desc .
Permit Fee.
207.00 Plan Check
Fee
134.55
Issue Date
. . . . Valuation
. . .
. 20000
Expiration
Date . . 10/02/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
18.00
----------------------------------------------------------------------------
9.0000 THOU BLDG 2,001-25,000
162.00
Permit
. . . ELEC POOL PERMIT -RES
Additional
desc .
Permit Fee
. . . . 45.00 Plan Check
Fee
11.25
Issue Date
. . . . Valuation
0
Expiration
Date 10/02/07
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 10/02/07
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
------------------------------------------7---------------------------------
Special Notes and Comments
POOL, SPA,
ALARMS/BARRIERS SHALL BE IN
LQPERMIT
Application Number . . . . . 07-00001042
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION. GAS &
ELECTRIC APPROVED FOR FUTURE APPLIANCES
BY SEPARATE PERMIT.
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
Bin #
City of La Quinta .
Building ex Safety Division
Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
2P.O.
Permit #
Project Address: I
Owner's Name: J�(
A. P. Number:
Address:g 1 -7-7�p
Legal Description:
Contractor: M I' l
Address: BO"
City, ST, Zip:
Telephone:
Project Description: WL L+ E'
City, ST, zip:
Telephone: �
State Lie. # : ; Nj�
_
—�z rj -
q
ZZ417
City Lic. #:
dor f2- 7.tst'LCbL�i
r
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
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: Ci (o
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'd
TRACKING •
PERMIT FEES
Plan Sets
Plan Check submitted
,y
t Z
Item
Amount
Structural Caics.
Reviewed, ready for corrections
Plan Check. Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance 'a
Energy Calcs.
Pians Sicked up
Construction
Flood plain pian
Plans resubmitted
Methanical
Grading. plan
I" Review, ready for corrections/issue
Electrical
Subcontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
q
41
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