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05-4878 (SOTB)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T-vf °F 4 Q" Application Number: 05-00004878 Property Address: 81917 COUPLES CT APN: 764-060-039- _ - Application description: STRUCTURES OTHER THAN BUILDINGS Property Zoning: LOW DENSITY RESIDENTIAL .Application valuation: 500 Applicant: Architect or Engineer: e11 � A_,/eL) ex,� BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ------------ -------------------------- --- -------------------------- LCECONTRACTOR'S 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 Profe_ ssionals Code, and my License is in full force and effect: U ense Casa: 'cense No.: Date: ConVactor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjurythat I am exempt from the Contractor's State Ucense'Law for the following reason (Sec..7037.5, Business and Professions Code: Anycity or county that requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance, also requires the°applicam-for the permit to file a signed statement that he oushe is licensed pursuant to the provisions of the Comractor's. State License Law (Chapter 9 Icommencing with' Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempttherefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permitsubjects the applicant to a civil penalty of not.more than five hundred dollars (0800).: (_ 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 thathe or she did not buiWor improve for the purpose of sale.). 1 _ 1 I; as owner of the'property, am exclusivelycontracting 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 contractors) 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 concoction lending agency for the performance of.the work:for which this permit is issued (Sec. 3097; Civ. C.). Lender's Name: Lender's Address: LQPERdIIT Owner: TEGELLER 81-917 COUPLES COURT LA QUINTA, CA 92253 Contractor' BUBBLE SPRINGS WCC: STATE FUND WC: 168541205 CSLB: 728796 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/02/05 106 2 2005 CITYO.F LA pi I,"-- -------=----------------------LA�D�P"�--- — WORKER'S COMPENSATION DECRATION �. 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 Jfissued.. / have and will maintain workers' compensedoninsurance, as required by Section 3700 of the Labor T' Code, for the performance oi'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 employany mns 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. #* workers' compensation provisions of Section 37,00 of the Labor Code, I sirs forthwith. ply with those provisions. Dea%mac + Appli.::: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,.AND'SHALL SUBN.E JECT AMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (9100,000). IN ADDITION TO THE COST OF'COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 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. I . Each person upon whose behalf this application is made, each person at whose request and for whose bensfit.work'is performed.under or pursuant to any parmitissued as a result of this application, the owners 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 becomes null and void if work is not commenced within ISO days from date of issuance of such permit, or cessation of work for ISO days will subject _permit to cancellation. I certify that 1 have read this application and, state, thattheabove information is correct. I agree to comply with all city and coq -ordinances and state laws relating to building constru tion, and hereby authorize representatives of this 4o nfer upon the above-mentioned propertyfor inp ion p Doses. Date:.) Signature (Applicant or Agent):✓ :r t Application Number . . . . . 05-00004878 Permit. . . . BUILDING PERMIT Additional desc . Permit. Fee . . . . 15.00 Plan Check Fee 9.75 Issue Date . . . Valuation . . . . 500 Expiration Date . . 5/01/06 Qty Unit Charge Per Extension BASE FEE 15.00 Permit. . . . PLUMBING Additional desc . . Permit Fee . . . . 18.00 Plan Check Fee 4.50 Issue -Date . . . Valuation . . . . 0 Expiration Date 5/01/06 Qty Unit Charge Per Extension BASE FEE_ 15.00 1.00 3.0000.EA PLB GAS PIPE 1=4 OUTLETS 3.00 --------------------------------------------------------------- Special Notes and Comments --------------------- FIREPIT ONLY. -- - - - - - -- - - - - - - - - -- — Other Fees . - - - - - -- - - -- - -- -- . . . . . . ENERGY -- REVIEW FEE 98 Fee summary ChargedPaid Credited - Due Permit.Fee Total 33.00 .00 .00 33.00 Plan Check Total 14.25 .00 .00 14.25 Other Fee Total .98 .00. .00 .98 Grand Total 48.23 .00 .00 48.23 lilt Tik : Torches RE. VO + SAm Out with Um 1 F— Equipment Location Fo mv % W Torches: A* iPOOL 34'x 16,61 AL1,i FOR BUBBLt Troy Tegeller The Palms -- Lot #5 S `S 3-5 949 119.11 = If 81917 Couples Court. La Quints, Ca 92253 Bin # City of La Quinta Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # D5 V Project Address: I 1-1 Cu-4)LE--> LT Owner's Name: 74 Elax A. P. Number: Address: �lq �, cck) Lo C-1 Legal Description; 1(111)- L {' f 1t2ry City, ST, Zip: L k W iy?. A (, 01 Contractor:/(3(� �(Z,gJ(r� Telephoner - Address: Address: 1pkt . (SX (04 (D Project Description: IV -3 S7 Aj,(, City, ST, Zip: it', �(il% (hi/%�%C� Ci Cl Z Z%U �� {✓� I%i RC Telephoner State Lie. # :: (/y�1 ri% C City Lic. #: Arch., Engr., Designer:. ft y 1 N(- ( !� ►2�S S Address: City, ST, Zip: Telephone: State Lie. #: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: 5��'� Sq .Ft.: F#St6ries: # Units: Telephone.# of Contact Person: Z,� � - (Q ZZ Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING. PERMIT FEES 2 Plan Sets Plan Check submitted I1 1 Item Amount Structural Calm Reviewed, ready for corrections Plan Check Deposit Truss Calm Called Contact Person Plan Check Balance Energy Cales. Plans picked up Construction O-rg Flood plain plan Plans resubmitted Mechanical Grading plan rA eview,.ready.for correctionslissue Electrical Subcontactor Listal kj a c erson Plumbing g 1— &AW ou >r Grant Deed (i a Arr S.M.I. H.O.A. ApprovalF 1 s it PT. Grading IN HOUSE:- j ! TTnn,, 7rd Revi `, fcd oons/iss Developer Impact Fee Planning Approval- _ ed C ct Pe A.I.P.P. Pub. Wks. -Appr Dat of per ue School Fees Total Permit Fees