09-1107 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
461'i6k. ' "
io 9`0`0 0,0 1 3X7
78658 PEERLESS PL
770-310-007- -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
15500
c&t!t . 4 4vQ-"
'Architect be Engineer"_.
�l
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BARBER
78658 PEERLESS PLACE
LA QUINTA, CA 92253
Contractor:
AZURE"POOLS AND -SPAS
-P.O. BOX 10641
PALM,:DESERT, CA 92255
(760)322-7665
Lic. NQ.: 802§19
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/16/09
o
D
..CCT 2° � 2009
CIT1('(�� LA QUINTA
— — — — — — — — — — — — — — — — — _
t LICENSED CONTRACTOR'S DECLARATION, WORKER'SCOMPENSATION DECLARATION
I'hereby affirm under penalty.of perjury that I am licensed.under proyisions'of Chapter.9. (commencing with I .hereby affirm,under penalty of.perjury one oll'the'Jollowingdeclarations:
Section 7000)'*of.'Division 3 of'the Business and Professionals Code, and my License is�in full force and effect. _+have and will maintain a certificate of consent toself-insure fonworkers;:compensation, as provided
9
License.Class: C53 - ^. License No.: 80291- for. by'Section.3700'of the'Labor Code, for the performance of.the %46 k for which this permit is
.y. issued. .1 -.
ate ntractor'. r - , . I have and'will maintain workers' compensation insurance,, as-requiied by. Section. 3700 of the Labor .
'Code, for the, performance of the work.for which this permit is issued: MVworkers' compensation
° OWNER -BUILDER DECLARATION insuiance'carrier;andpolicynumberare:
I hereby affirm under penalty of perjury that I am exer4t:from the Contractor's State License Law for the', Carrier DELO& INS -'CO. z .. Policy -Number •02DKRM120027.94 -
following -reason (Sec. 7031.5;-Busruess.and Professions Code:: Any cny or county..that requires a perrrmii'to - _. I certify that, in the performance of.the work -for which this permit is issued, Pshall nof'employ. any
.construct,'41ter, improve -demolish, or repair any structure,'priorto its issuance, also.requires the. applicant for the - . person'_in any :manner so as Wbeicome'subject to the workers'.compensation laws of California,
permit tofile a signed statement that he or she is- licensed'pursuant.tothe provisions of the Contractor's State _ and:agree That; if,l should become subject' the workers'compensationprovisions of Section
License Law (Chapter 9 (commencing'with-Section 7000) of Division 3 of the Business. and Professions Code) or - 7 of the Labor Cod sha •wit 'c reply with•itiose provisions.
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 perain-subjects the applicant to a civil penalty Of not more thanhve hundred dollars ($500).:
(_ 1 1,;as owner of the property, or my employees with wages as their sole co mpensation,-will do the work, and
'
the structure is not -intended or offered.forsale (Sec. 7044, Business and Professions Code: The,
C644&ors' State License Law does'nof apply to an owner of property who builds or improves thereon,
and who does the.work himself -or heiself,thiough his or, her own employees, provided that the
improvements are not intended or offered for sale. .If, .howe'ver, the building or;improvement is sold within
one'year of completion;.the owner -builder will liave,the burden of proving that he or.she did not build or
improve for the purpose'of sale.).
I _ 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 acontractor(s) licensed
. pursuant to the Contractors' State License Law.).
(_ I 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
, plicant.
1,15
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE•IS UNLAWFUL, AND SHALL.
SUBJECT'ANEMPLOYER TO CRIMINAL PENALTIES ANDCIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100;0001. IN ADDITION TO.THECOST 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.workis performed under_or pursuant to -any permit issued'as a result of this application,
the owner, and the applicanW'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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to buil ' g construction, and hereby authorize representatives
. o{this' ou�ty�]to'�e upon the bode -mentioned grope y My9ses.
D : t V� Si ure (Applicant or Agent):
Application Number . . . . . 09-00001107
Permit BLDG POOL PERMIT
Additional desc
Permit Fee
171.00 Plan Check Fee..
_
111.15
Issue Date . . . .
Valuation . . .
. 15500
Expiration Date
4/14/10
Qty Unit Charge
Per
Extension
BASE FEE
45.00
14.00 9.0000
---------------------------7-------=------------------------------------7---
THOU BLDG 2,001-25,000'
126.00
Permit . . . MECH POOL
_. Additional desc,. ,
Permit F.ee
26.00 Plan Check Fee
6.50
Issue Date
Valuation . . .
. 0
Expiration Date
4/14/10
Qty Unit Charge..'Per
Extension
BASE FEE
15:00
1.00 11.000.0
EA MECH FURNACE >100K
11.0.0
Permit .CLEC POOL PERMIT -RES
"Additional desc .
Permit :Fee -
45.00 Plan Check Fee
11.25
Issue Date
Valuation
0
Expiration Date
4/14/10
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
27._00 Plan- ;Check Fee
6.75
Issue Date . . .
Valuation
0 .
. Expiration Date
4/14/10
Qty Unit Charge
Per.
-Extension
BASE FEE
15.00
1.00 6..0000
EA PLB •FIXTURE
'6.,00
1.00 3.0000
EA, PLB WATER''INS.T/ALT/REP
3.00
.1.00 3.0000
EA PLB GAS PIPE -1-4 OUTLETS.
3.00
Special Notes and Comments
SPA & EQUIPMENT ONLY AT THIS TIME.
LQPERMIT
Application Number . . . . . 09-00001107
----------------------
Special Not and Comments
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 Paid
Credited
Due,
Permit Fee Total 269.00 .00
.00
269.00
Plan:Check Total. 135..65 .00
.00
13.5.65
Other Fee Total ,1.00 .00,
.00
1.00
Grand. Total 40,5..65. .00
0:0.:..
4.05.65
LQPERMIT
Bin #
City Of Ld•Qum,ta
f Building & Safety Division_--
P.O. Box 1504, 7&495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
'Building Permit Application and. Tracking Sheet
Penr it #
n CA
1
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: 7F77o
Telephone: ;�a:'i'•i,,'y>-:>;?.,;::.;:;�;:•.:: ;.:� ri•�:#::
Address:
Project Description: -
City, ST, Zip:. /'pvl �i Z
Telephone• 2/-ZQ
ii�k'':>-'iii'�>Sn::::}'J��'r?',•':.i>i<i.i«Yrr%{C>S�i'�S::(`?{i:4i;`iF:�A>'J'i'F::k's v>$?:.Y:�;ff.{cS�:::•YFf•'}s?Cn�•S)iy#";:v:zr::;>Si.
State Lic. # : i City Lia M.
Arch., Engr., Designer.
Address: f�
City., ST, Zip: ; "
�{ �ti'^�:'.•'.•��}:F�i�ii$i:: vi:f,:i�'.�:iS�f`l::.:�:`r'n�Lt
hone
State Lic. #: �.
Name of Contact Person:
nstruction Type: /vI
CoTele
iOccupancy:
ProJ ect tYPa circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories`. # Units:
Telephone # of Contact Person: —
Estimated Value of Project: 4' e—, U
APPLICANT:-.DO-POT WRITE.BELOW THIS LINE
#
Submittal
Req'd
-Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
' l�
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 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
M HOUSE:-
''d Review, ready for correetionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks..Appr
Date of permit issue
School Fees
Total Permit Fees
EIREMEH.-SE'R, z�. r ,^F^'P
I