06-3807 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
06-00003807
43620 CORTE DEL ORO
609-580-052- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
28000
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury :ha am li nsed under pro ons of Chapter 9 (commencing with
Section 70001 of Division 3 of the Busin s d o ssio a Cod , an my License is in full force and effect.
License s: A -C -C8 cens No 840210
ate: �� �� D tP tractor:
OWNER -BUILDER D RATION
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
permitVo 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).:
(_) 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:
LQPERAIIT
Owner: -
GREG WILSON
43620 CORTE DEL ORO
LA QUINTA, CA
LA QUINTA, CA.92253
Contractor:
CROCODILE CONSTRUCTION
52121 FILLMORE STREET
THERMAL, CA 92274
(760)360-5895
Lic. No.: 840210
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/27/06
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.
ave 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 18 B32-2006
1 certify that, in the performance of th ark for which is pprmit is issued, I shall not employ any
person in any manner s bec subj t toth wo r mpensation laws of California,
and agree that, if I sh Id be me u act t t w I ers' omp nsation provisions of Section
(� ..tt7//00 of the Labor de, I sh II f t ith c ly w h t se pr vis' ns.
Date: " Vr/` plicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COV\41AGE 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 Quints, 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 beco null and void f work is' no 'commenced
within 180 days from date of issuance of such per it, r ces anon o work for days will subject
permit to cancellation.
I certify that I have read this application and state toildm
info ati i cor I agr to comply with all
city and county ordinances,, and to laws relating tstr toPPn, her by a hor a representatives
of this..edynty tb enter upoa above-mentioned pp tigh p p ses.
e� 8�
V Signature (Applicant or Agent):
Application Number . . . . . 06-00003807
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 271.50 Plan Check Fee 176.48
Issue Date Valuation . . . . 28000
Expiration Date 4/23/07
Qty Unit Charge Per Extension
BASE FEE 252.00
3.00 6.5000 THOU BLDG 25,001-50,000 19.50
----------------------------------------------------------------------------
Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/23/07
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 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 4/23/07
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 . . 4/23/07
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
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
LQPERIIIT
Application Number . . . . . 06-00003807
----------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 375.50 .00 .00 375.50
Plan Check Total 202.48• .00 .00 202.48
Grand Total 577.98 .00 .00 577.98
LQPERAI IT
Bin ffCity
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:Y
Project Address: 3" �a0 co+e Ir d o rz) Owner's Name:
A. P. Number:
Address: 4:,z &'�-Q CO (' C DO 0('?)
Legal Description:
Contractor: Uocod( le, CaviwL(CI (C7{'V
City, ST, Zip: 1-k uL oz -VN Com' S-3
Telephone:
Address:nn111 `
Project Description:
.City, ST, Zip: QC PVI � � ' (Pa. -7
D �
Telephone:
State Lie.
City Lie. #:
Arch., Engr., Designer:
Address: -
Plans picked up
City,: ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person: N ldc,
Construction Type: Occupancy:
Project'type (circle one): New Add'n Alter Repair Demo
�(Sq: Ft.: # Stories: #Units:
Telephone # of Contact Person: F7S'- W0", l
Estimated Value of Project: f0A.19
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Plan Sets
Req'd _
Rec'd
TRACKING.. PERMIT FEES
Plan Check submitted Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Energy Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plau
2" Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
I-I.O.A. Approval
Plans resubmitted..
Grading
IN HOUSE:-
'''Review, 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
Total Permit Fees : .,
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