09-1029 (RPL),
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tit!t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 09-00001029
Property Address: 48590 CAPISTRANO WY
APN: 646-390-036- - -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 25000
Applicant: Architect or Engineer:
JI�
----------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury th I am licensed un er provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busines and Profess' s Code, and my License is in full force and effect.
License C ss:�vwt.r:
C8,10,27 "
8,10,27, License No.: 656128
ate:
OW R -BUILDER DECLARA
I hereby affirm under penalty of perjury that I am a mpt 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 peiinit.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.).
(_ 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:
LQPERMIT
Owner:
GIBSON
48590 CAPISTRANO WAY
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/24/09
piI
U t
Contractor:
TESERRA F1p 1 }jj
P.O. BOX 1280 S 2' 2u
COACHELLA, CA 9223( .1
(760) 398-9222 1 CITY OF LACli.WNTA
Lic. No.: 656128 rIN..I ?.'.i n;_:rs:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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 SEABRIGHT Policy Number BB1080510
I certify that, in the performanc the work for which this permit is issued, I shall not employ any
person in any manner so as to b me su ' ct to the workers' compensation laws of California,
and agree that, if I should becom su j t the workers' compensation provisions of Section
3700 of the Labor Code, I shall f wi ly with those provisions.
te: plicant:
WARNING: FAIL E TO SECURE WORKERS_' PEN TION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE IES AND C L FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO T COST OF COM SATION;-DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORN l5 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 *licationbecomes es null and void if work is not commenced
within 180 days from date of issuait, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and statmation is correct. I agree to comply with all
cityand cc my ordinances and state laws relatinruction, and hereby authorize representatives
of this my to enter upon th above-mentionecoon purposes.
D e:pplicant okge
J
LQPERM IT
Application Number . . . . . 09-00001029
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 252.00 Plan Check Fee 163.80
Issue Date . . . . Valuation 25000
Expiration Date 3/23/10
Qty Unit Charge Per Extension
BASE FEE 45.00
23.00 9.0000 THOU BLDG 2,001-25,000 207.00
----------------------------------------------------------------------------
Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . . 26.00
Issue Date . . . .
Expiration Date . . 3/23/10
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 . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
ELEC POOL PERMIT -RES
45.00 Plan Check Fee . . 11.25
Valuation . . . . 0
3/23/10
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
Issue Date . . . .
Expiration Date . . 3/23/10
Plan Check Fee 8.25
Valuation 0
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,
FIREPIT (UL
APPROVED FIRE
Application Number . . . . . 09-00001029
----------------------------------------------------------------------------
Special Notes and Comments
RING)GAS STUB -OUT &GFI. ALARMS/BARRIERS
SHALL BE IN PLACE AT PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED. 2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged
Permit Fee Total 356.00
Plan Check Total 189.80
Other Fee Total 1.00
Grand Total 546.80
LQPERMIT
Paid Credited Due
.00 .00 356.00
.00 .00 189.80
.00 .00 1.00
.00 .00 546.80
- Bin #
CIL/ Of .a QUlnta
Building & Safety Division
P.O. Box 1504, 78-.495 Calle Tampico .
;
La Quinta, rA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1p
Project Address: � ow'
Owner's Name: 7 d�0
A P. Number: �%
Address:
Legal Description:
Contractor: ZP---i5- a4
City, ST, Zip:
Telephone:
Address: 9(-r,-100 AVE
Project Description:
City,ST,Zip: (fO = L(2,4- 7-7-.36,
�
Telephone:
State Lic. # : City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft: 577#Stories: —T# —Udlts:
Name of Contact Person:`
Telephone # of Contact Person:.
Estimated Value of Project: 5
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal'
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Cheek Balance
Energy Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted .
Mechanical
Grading plan
2vd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SJYLL I
H.OA. Approval.
Plans resubmitted
Grading
IN HOUSE:-
1n° 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
Total Permit Fees