10-1071 (RPL)r it
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
A —li—t.
(r.- �'4 4 Q� �
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
10-00001071
77933 CALLE COLIMA
774-134-012-2 -000000-
POOL - RESIDENTIAL
COVE RESIDENTIAL
22300
A—hit—t or Engineer:
)(A
ICLARATION
s of Chapter 9 (commencing with
my License is in full force and effect.
658996
RATION
ctor's State License Law for the
or county that requires a permit to
uance, 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 of not more than five hundred dollars ($500).:
1 _ 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 _ 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:
L'ender's Address:
LQPERMIT
Owner:
TERRY ACKERMAN
77-933 CALLE COLIMA
LA QUINTA, CA 92253
Contractor:
FAMILY POOLS CONSTRUCTION
P 0 BOX 283
LA QUINTA, CA 92247
(760)564-3655
Lic. No.: 658996
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/18/10
.��[rz1 U
OCT 2 0 20_1_0.__�i
GITY OF LA QUINTA
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 the work for which this permit is issued. My workers' compensation
insurance carrier and policy number
Carrier STATE FUNDicy Number
not employ any
erson in any man o as to become subject to the workers' compensation laws of California,
nd agree that Id becom subject to the workers' compensation provisions of Section
9 1 P
of Jh abor q e,�l, shplj�thwith comply with those provisions.
WARNING FAILURE TO SECURE WO ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT N EMPLOYER TO CRIMINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND -
DOLLARS ($100,0001 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 act or omission related to the work being
performed under or following issuance of this it.
2. Any permit issued as a result of this pli n becomes null and void if work is not commenced
within 180 days from date of issua of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify at I h ve read this application an tat hat the above information is correct. I agree to comply with all
city a d unt rd' ances d state laws ti • t buildin construction, and hereby authorize representatives
of o ntt o up the above -men or spection purposes.
IV)at 1 nature (Applicant o ge 1:
r I
Application Number . . . . . 10-00001071
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
234.00 Plan Check
Fee
152.10
Issue Date . . . .
Valuation
22300
Expiration Date
4/16/11
Qty Unit Charge
Per
Extension
BASE FEE
45.00
21.00 9.0000
-----------------------------------------=---------------=------------------
THOU BLDG 2,001-25,000
189.00
Permit . . .
MECH POOL
Additional desc . .
Permit Fee . . . .
26.00 Plan Check
Fee
6.50
Issue Date . . . .
Valuation
0
Expiration Date . .
4/16/11
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 . .
4/16/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.00.00
----------------------------------------------------------------------------
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
4/16/11
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/BARIERS
SHALL BE IN
LQPERMIT
C J.
LQPERMIT
Application Number . . . . . 10-00001071
----------------------------------------------------------------------------
Special Notes and
Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. 2007
CODES.
-----------------------------------------
Other Fees . .
----------------------------------
. . . . . . BLDG STDS
ADMIN (SB1473)
1.00
Fee summary
-----------------
Charged Paid
--------------------
Credited
--------------------
Due
Permit Fee Total
338.00
.00
.00
338.00
Plan Check Total
178.10
.00
.00
178.10
Other Fee Total
1.00
.00
.00
1.00
Grand Total
517.10
.00
.00
517.10
1,�
Bin #
City of La Quinto
Building Br Safety Division M
P.O. Box 1504, 78-495 Calle Tampico
La Quanta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #Oq 1
Project Address:Owner's
Name:
A. P. Number.
Address:
Legal Description:
City, ST, Zip:
Contractor: / 6(7'�S
Telephone:
Address:
Project Description:
City, ST, Zip:
'kms-'
Telephone: �j
State Lie. #: City Lie. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: a
State Lie. #: ` %''"�
. f^d'f. .. �R /
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories-,# Units:
Telephone # of Contact Person: Q —
Estimated Value of Project: pl
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'dPERMIT
FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for correction
Plan Check Deposit
Truss Cases.
Called Contact Person
Pian Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
god Review, ready for correctionsfissue
Electrical
t
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.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
.7[Total
=Permit
I
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRUCTION
DATE I0- 2-0- W BY g K
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