06-1112 (RPL)P.O. BOX 1504, VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA-QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number:
Property'Address:
APN:'
Application description:
Property Zoning:
Application valuation:
Applicant:
106 _00001112'"
49930 PATTI CT
649-520-998-2 -290533-
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000"
Architect or Engineer:
Owner:
PM RENAISSANCE,LLC
9968 HIBERT STREET, STE. 102
SAN DIEGO, -CA 92131
Contractor:
CALIFORNIA POOLS & S
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
Date: 3/17/06 1 -
' LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 70001 of Division 3 of the Busine and Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C8 C27 C29 License No.: 656128
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
%ate: Contractd-r
X 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under "penalty of perjury that m exempt from the Contractor's State License Law for the
Carrier HRH INS Policy Number B131060510 '
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct,alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is, licensed pursuant to the provisions of the Contractor's State -
and agree that, if. I should becorTIP subject to the workers' compensation provisions of Section
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
3700 of the Labor Code, I h hwith comply with those provisions.
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
�: G Applica
(_) 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
WARNING: FAILURE TO SECURE WORKERS'OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENAL IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). -
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. '
property who builds or improves thereon, and who contracts for the projects with a contractor's) licensed
1. Each person upon whose behalf thj§ egglicatinn is mado, eanh pQroon n1 v:haaa -quear aiiii fui
pursuant to the Contractors' State License Law.).
wnose Benefit work is performed under or pursuant to any permit issued as a result of this application,
I 1 I am n.nmpt undar Cha: o.ar.u. rar tnis reason
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.
Date: Owner:
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
• CONSTRUCTION LENDING AGENCY
permit to cancellation..
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all .'
. work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building uction, and hereby authorize representatives
Lender's Name: '..
of thi county to enter upon the above-mentioned propert fo ec ' n "purposes. -
Lender's Address:
Date: L Signature (Applicant or Agent
t
LQPERMIT
Application Number .
•
. . . . 06-00001112
c
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee .. . . .
207.00 Plan Check Fee
134.55
Issue Date . .
Valuation . . .
. 20000
Expiration Date
9/13/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 '9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
162.00
Permit . . .
MECH POOL
Additional desc .
4 Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation
0
Expiration Data
9/13/06
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
9/13/06
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
8.25
Issue Date . . . .
Valuation
0
Expiration Date
9/13/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 6.0000
EA PLB FIXTURE
12.00
t . UU . 3 . UUUU
EA P1,8 WA'1'EK 1NST/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/BARRIER SHALL
LQPERMff .
Application
Number . . . . . 06-00001112
-------------------------------------------------------
Special Notes and Comments
--------------------
BE IN PLACE
PRIOR TO PRE -PLASTER
INSPECTION.
EQUIPMENT ENCLOSURE NOT
INCLUDED IN
PERMIT.
Fee summary
Charged Paid
Credited.
Due.
Permit Fee
- ----------
Total 311.00 .00
---------- ----------
.00
311.00
Plan Check
Total 160.55 .00
.00
160.55
Grand Total
471.55 .00
.00
471.55
Bin #
Permit #
Project Address: �� 9W
A. P. Number:
Legal Description:
Address:�Z
City, ST, Zip C
Telephone: •76C 3i I ZZ
State Lic. #
Arch., Engr., Designer:
Address:
- City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
City of. La Quint'a
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
Owner's Name: -i�_ _-
Address: vti
City, ST, Zip:
Project Description:
Lic. #:
Construction Type: Occupancy:
Project type (circle one): Add'n Alter Repair Demo
Q Sq. Ft.: # Stories: # Units:
Estimated Value of Project:.`,
Total Permit Fees
APPLICANT:
DO NOT WRITE BELOW THIS LINE
f/
Submittal
Req'd
Recd
TRACMG .
TERMIT FEES
Plan Sets
Plan.Check submitted
3/Item
/ 7
Amount
Structural Calcs.
Reviewed; ready for corrections
Plan Check Deaosit
Truss Calcs.
Called Contact Person
Plan Check Ba ance
Energy Calls.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan'
r' 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
Total Permit Fees