09-0369 (RPL)P.O. BOX 1504
78495 CALLE TAMPICO
LA. QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property .Zoning:
Application valuation:
Annlirant:
09-00.000369
81651 CHARISMATIC WY
767-640-010- - -
POOL - RESIDENTIAL.
LOW DENSITY RESIDENTIAL
20000
Architect or Engineer:
alp
---------- I ------- I _.
LICENSED CONTRACTOR'S DECLARATION
M
BUILDING &. SAFETY DEPARTMENT
BUILDING PERMIT
Thereby affirm under. penalty of perjury a am lice provisionscof Chapter 9 (commencing with
Section 7000) of Division 3 of the Busi P e ode, and ,my License is.in full; force and effect.
Lice C , 10, 27, 2 'cerise No.: 656128 _
ate:. tractor.
NE"OLDER DECLARATION
I hereby affirm under penalty of perjam exempt from the Contractor's State License Law for the
following reason.(Sec. 7031.5, Busiury nd Professions Code:. Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, priortoits 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 Contrector.'s State
License Law (Chapter 9 (commencing .with Section 7000)of Division "3 of the Business and Professions Cade) 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).:
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. 70"W.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 emplcyees,providedthat 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.).
L_) I, as owner of the.pro
party, am exclusively contracting with licensed contractors to construct the project (Sec.
70", Business and Professions Code:. The Contractors'State License Law does not applyto an owner of
propertywho builds or improves thereon„and who contracts for the projects with a contractorts) licensed
pursuant to the Contractors' State License Law.).
am exempt under Sec. , B.&P.C. for this reason
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is.s construction lending agency for the performanoe:of'the
work for whichthis`permit is issued (Sec. 3097, Civ. Ca.
Lender's; Name:
Lender's Address:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Dater 4/24/0'9
Owner: ! .0
RUSSO Q
81651 CHARISMATI_
LA QUINTA, CA 9 5 qpD
(7610)777-9920
0111, 7
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic.'No.: 656.128
------------------
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 self4nsureforworkers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
r • 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performahce-of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier SEABRIGHT Policy.Number
_ I certify that, in the rformance work for which this permit is issued, Ishall not employ any
person imany mann , o as to subject to the, woikers' compensation laws:of California,
and agree the if I shoo m su - workers' compensation provisions oYSection
3700 oft LaborCode, I shall it omply with those provisions.
WARNING: FAIL EEURE WORK S' MPENSAT COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL LTIES AND CIVIC S UP TO ONE HUNDRED THOUSAND
DOLLARS (81.00;000)• IN ADDITION TO THE COST OF'COMPENSA ON, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Directobof Building and Safety fora 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 Le Ouinta,,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 isnot 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 count ordinances and rel irI building construction, and hereby authorize representatives
oft to enter up :the ri11G� _rtyfor Inspection purposes.
at a IAp ant
E
WPERMrr
Application Number . . . . . 09-00000369
Permit BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 198.00Plan Check Fee 128.70
Issue Date . . . Valuation . . . . 185.60
Expiration Date . . 10/21/09.
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
Issue Date . . . .
Expiration Date . .. 10/2.1/09
Plan Check Fee . . 6.50
Valuation . . . . 0
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
escPermit Fee . . . 45.00 Plan Check Fee 11.25
Issue Date . . Valuation . . . . 0
Expiration Date 10/21/09
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING'POOL 30.00
Permit . . .
Additional desc .
Permit Fee
Issue Date
Expiration Date .
PLUMBING'
33.00
10/21/09
Plan Check Fee . . 8.25
Valuation . . . . 0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
2.00
6.0000
EA
PLB FIXTURE
12.0.0
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
Application Number . . . . . 69-00000369
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 35.00 Plan Check Fee'.
.00
Issue Date Valuation . . .
. 1440
Expiration Date 10./21/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
10.00 2.0000 FIND BLDG 501-2,00.0
20.0.0
- -----------------------------
Special Notes and Comments
POOL/SPA BBQ ,& FIREPIT, 8:0 L.F. 4'
RETAINING WALL, 10 L.F. 4' EQUIPMENT
ENCLOSI7RE. ALARMS/BARRIERS SHALL BE IN
.
PLACE AT PRE -PLASTER INSPECTION.
----------------------------------
- --
Other
Other Fees . . . . . . . BLDG SIDS ADMIN (SB1473)
------ -----
1.00
Fee summary Charged Paid Credited
----------------- _ -.----------------
Due
.,_ ----------
Permit Fee Total 337.00 .00 .00
337.00
Plan Check,Total 154.70 .00 .00
154.70
Other Fee Total 1.00 .00 .0,0
1.0.0
Grand Total 492.70 .00 .00
49.2..70
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DESERT
MHNHGEMENT-
76.08621.2.10
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760062.1210
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ARCEiITECTURAL COMMITTER CERTIFICATE
{Exhibit,"A" to theArchitochiral .
- .Irnprovembnt Applieation and Allmeameno
The Architectural Impmvement Application and Agreement was raviawed by the
Architectural Committee on
and has.been:
Approved Canditfoaalljr Approved Rejected
u J� o Io
Canditiow net
Retumed for Flusher Wbrination
Required Modificadorar 'Aa
Comments
Yes No
Recording to be seat by'owner'to Coftity Recorder'@, office for .roof and/or. -
exulllor wall modi�ficotions.
Depodt Required Deposit S .
..Dame
Ascbitectuaral Committee -Architectural C60=ittee
AroltitecWaal Committee . Atchitactruat Committee
tgoTE: THIS APPROVAL IS VALID FOR 90 DAYS FROM -APPROVAL DATE'
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Bin #
City of. La Quinta.
Building ex Safety Division
P.O. Box 1504, 78-495 Calle Tampico
4 Quanta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:.
e R/ % G
Owner's Name: �) O
A. P. Number:
fj %(/
Address:
.Legal Description: ---
Contractor.
_
4 r
- -
ra
City, ST, Zip: -
Telephone:
Address: b—
�&U
Project Description: dL d= p-00 0
City, ST, Zip:
riL-L.
2�9A Af F//2 -e- e*
Telephone: ZL—Z
�U SMlvdwd
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
.City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle.one): ew Add'n Alter Repair Demo
Name of Contact Person:
Sq. FL: 50 g
# Stories:
# Units:
Telephone # of Contact Person:7
g I
Estimated Value of Project: O
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Tress Cates..
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans ticked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
V Review, ready for correctionalsue
Electrical
Sobcontactor List
Called Contac Person,
Plumbing
Grint Deed
Plans picked up
SALL
ILO.A. Approval
Planwresubmitted
Grading
INiKOUSE:-
'`' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called "Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
Sck*i Fees
LI
� Total Permit Fees
a000 0
I S
5�