05-4566 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T-i&t °F 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-701'2
FAX (760) 777-7011 �-
INSPECTIONS (760) 777-7153
Date: 10/12/05
Application Number: 05-00004566 Owner:
Property Address: 81917 COUPLES CT 0 TEGELLER, TROY
APN: 764-060-039- - - 81-917 COUPLES STREET
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 32800 OCT 1'� 2005
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division'3 of the Business and Professionals Code, and.my Lioense,is in full force and effect.
License Class: License No::
Dat 0 �7�r Contractor:
OWNER. ER:DECLARATION:
t hereby affirm under'penalty of perjury that I am a rom the Contractor.'s State, license Law for the
following, reason (Sec, 7031:5, Business'and Prof a Code: Any city or county that requires a permit to.
construct, atter, improve,:demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file,a signed.staternent that he or she is licensed pursuant:to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Sect)on 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 (6500).:
(_)
[,.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 hersetfthrough 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.).
(_) 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 twan 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.).
l _) 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:
LQFERMTP
Contractor:
BUBBLE SPRINGS
WCC: STATE FUND
WC: 168541205 04/11/06
CSLB: 728796 12/31/06
-------------------
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 self4risure forworkers' compensation, as,proyided
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, Section3700 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 C53 -C35 Policy Number. ----------------
_ I certify that, In the performance of the work for which this permit is issued, I shall not employ any
person in any manner sous to become subject to the workers' compensation laws of California,
and agree that, if I should becom subject to,the workers' compensation provisions of Section
3700.of the LabiorCode, I t with cont with tffose provisions.
lzgi :/V 21"o'Si4pplicant:
WARNING: FAILURE TO SECURE RKERS' COMP N COVERAGE IS UNLAWFUL..AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES IVIL FINESMO TO ONE HUNDRED THOUSAND
DOLLARS (9100,000). IN ADDITION TO THE COST DF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S, FEES.
APPUCANT.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; esch.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 of following issuance of this permit.
2. Any permit issued as,a result of this application becomes null and void if work is riot 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 represente[Ives
of this to.enter upon the above-mentioned property or in purpos .
Dat /4i7Signature (Applicant or Agent),
Application Number . . . . . 05-00004566
Permit
Unit Charge Per
BLDG POOL PERMIT
Extension
Additional
desc . .
15.00
2.00
6.0000 EA,
PLB FIXTURE
Permit Fee
. . . .
304.00
Plan Check
Fee
197.60
Issue Date
. . . .
3.00
Valuation
. . .
. 3280.0
Expiration
Date . .
4/10/06
Qty Unit Charge
Per
Extension
BASE
FEE
252.00
8.00
6.5000
THOU BLDG
25,001-50,000
52.00
Permit
. . .
MECH POOL
Additional
desc .
Permit Fee
. . . .
26.00
Plan Check
Fee
6.50
Issue Date
Valuation
0
Expiration
Date
4/10/06
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
4/10/06
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
7.50
Issue Date
. . .
Valuation
. . .
. 0
Expiration Date . . 4/10/06
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 ONLY. ALARMS/BARRIERS SHALL
LQPERMT
A
Application Number . . . . . 05-00004566
----------------------------------------------------------------------------
Special
---------------------- - ---------------
Special Notes and Comments
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE .140T
INCLUDED IN PERMIT.
Fee summary Charged Paid Credited Due
Permit Fee Total 408.00 .00 .00 408.00
Plan Check Total 222.85 .00 .00 222.85
Grand Total 63.0.85 .00 .00 630.85
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 #
05-
Project Address: 7a� lr
Owner's Name:
A. P. Number:
Address:
Legal Description:
Contractor: ®�
Address:-7/ S
City, ST, Zip:
Telephone:
Project. Description: Dam
City, ST, Zip: �,,,,/
Telephone: 7� 7
State Lie. #': 7dZ-
City Lie. #,:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie, #:
ji,
Construction Type: Occupancy:
Project type'(circle one): New Add'n Alter Repair Demo
Name. of Contact Person: m�, I*.
Sq. Ft::
#Stories:
# Units:
Telephone # of Contact Person:S . %1
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
/0/2
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Cheek. Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical-
Grading plan
tad Review, ready for corrections/issue
Electrical
Subcontactor List.
Called Contact Person
Plumbing
Grant Deed
Plans picked tip
SALL
H.O.A. Approval
Plans resubmitted
Grading
.IN HOUSE:.
for correctionslissue
Developer Impact
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permifissoe
School Fees
Total,Permit Fees
rk
1+18" SDa with Stacked Quart;
i
SPA (8f)(8)
'5r0
POOL 34'x 16.5'
Swim Out with Umbrella Sleeve
Q
_.. 0
...................................................................................................................
CITY OF LA QUINT
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
pAT Io(t3/05BY S�
8'6 Troy Tegeller
The Palms -- Lot_ #5
Equipment SPRINGS 949.509.2114
'Location "Boo = 1 9/9/05
� _