08-1658 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Q"
Application Number: 08-00001658
Property Address: 50620 CYPRESS POINT DR
APN: 770-110-048-43' -25389 -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: MEDIUM DENSITY RES
Application valuation: 2800
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busin s and Professionals Code,And my License is in full force and effect.
License Class: C53 License o.: 897709
Kat /b ntractor:
OWNER -BUILDER DECLARATION
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
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—) 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.).
I_ 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/08/08
Owner:
ROGER LUNDEEN
50620 CYPRESS
LA QUINTA, CA
POINT
92253
Contractor:
JB POOLS AND SPAS
81955 HIGHWAY 111
INDIO, CA 92201
(760)347-4210
LiC. No.: 897709
INC
STE
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 are:
Carrier EXEMPT Policy Number EXEMPT
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the y0o
'ompensation laws of California,
and agree that, if I should come subje t to the worensation provisions of Section
3700 of the Labor Cod I hall forth h comply witvisions.
ateil"� ,cant:
WARNING: FAILURE TO SECURE ORKERS' OMPENSATIDN COVERAGE 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 Quinta, 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 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 infor tion is correct. I agre o comply with all
city and county ordinances and state laws relating to build, cdnstru ,on, and hereby tho a representatives
of this county to enter upon the above-mentioned prope r insp tion purposes.
ate/Q gf nature (Applicant or Agent):
Application Number . . . . . 08-00001658
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 54.00
Plan Check Fee
35.10
Issue Date . . . .
Valuation
2800
Expiration Date . . 4/06/09
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
-------------------------------------------=--------------------------------
9.00
Permit . . . ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . . 17.25
Plan Check Fee
4.31
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 4/06/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
3.00 .7500 PER ELEC DEVICE/FIXTURE
1ST 20
2.25
----------------------------------------------------------------------------
Special Notes and Comments
BUILD BBQ. 36" AOG (Z2231/NFP054,
60,000 BTU). 75 L.F. 3/4" GAS LINE
PREVIOUSLY INSTALLED AND INSPECTED.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ENERGY
REVIEW FEE
3.51
STRONG
MOTION (SMI) - RES
.50
Fee summary Charged Paid
---------------------------
Credited
Due
----------
Permit Fee Total 71.25
--------------------
.00- .00
71.25
Plan Check Total 39.41
.00 .00
39.41
Other Fee Total - 4.01
.00 .00
4.01
•Grand Total 114.67
.00 .00
114:67
LQPERMIT
o ocp--
62D
�, �
to' C�A
sjgv7/.z:'
lod C-lAf
4M ELS \1
IC -1c
1 .0
,CITY OF LA QUINTA
CITY
BUILDING & SAFETY DEPT. gig&
APPROVED
FOR CONSTRUCTION
,t LD
ATE By
—.9c,
� CITY OF LA QUINTA SUR -CONTRACTOR L ST
JOB ADDRESS.'v) ``'FIs PERMIT N'�3iVIt3ER OWNER �'' _BUILDER =1 A)('
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuousplace. Onl ersons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade / Classification.
Contractor
":"'': ':': ` ``S at :. o tr
t . e C n actors. license ..
Workers C.om . gsatlon;Insu�ance: ` <' ' - , ::.
City Business License:
Company Name
Classification
(e.g. A. B, C-8)
License Number
(xxxxxxl
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
CONCRETE (C-8)
FRAMING (C-5)
STRUCT. STEEL (C•51)
MASONRY (C-29)
PLUMBING (C-36)
LATH, PLASTER (C-35)
DRYWALL (C-9) .
HVAC (C-20)
ELECTRICAL. (C-10)
ROOFING (C=39)_ >:
`SHEET METAL (C-43)
FLOORING (C:=.95)
GLAZING (C-17)
INSULATION' (C-21.4
SEWAGE DISP: (C-42)
PAINTING (C=33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
_
-JIVA
AQUC ki
Bin #
City of La Quinta
Building'& Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #�(^�
1 J
Project Address:50
Owner's Name:
Address:
A. P. Number:
Legal Description:
City, ST, Zip: i e4—
Contractor:
�S I We-,
Telephone:
Address:.OQ 4,
Project Description:
City, ST, Zip:L
a
Telephone:
Gi�eUf
State Lic. # : 91-7'709
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories: #Units:
Telephone # of Contact Person: Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Ree'd TRACKING PERMIT FEES
Plan Sets Plan Check submitted 3 Item Amount
Structural Calcs.
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Plan Check Balance
Energy Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
god Review, ready for corrections/issue Electrical
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
A
ETY D PT. Total Permit Fees
AF'PROVEID
FOR cONSTRUCT
DATEAY&BY —
50620 Cypress Point Dr