09-1133 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,. CALIFORNIA 92253
Application Number: 09=000011-33
Property Address: 78658 PEERLESS PL
APN: 770-310-007- - -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 28500
Applicant: ) Architect or Engineer:
� IA
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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 Business and Professionals Code, and my License is infullforce and effect.
License Class: C53 License No.: 802919
Contractor: -
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that lam exempt from the Contractor's State License Law for the
following reason ISec. 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 1, 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 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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:
LQPERA11T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/28/09
Owner:
BARBER
78658 PEERLESS PLACE
LA QUINTA, CA 92253
Contractor:
AZURE POOLS A
NP'.O. BOX 106PALM DESERT,(760)322-766ECLic. No.: 80
02 2009
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WORKER'S COMPENSATION'DECLAR
I hereby affirm under penalty of perjury one of the fallowing 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 370o 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 DELOS INS CO Policy Number 02DKRM12002794
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 workers' compensation laws of California, .
and agree that, if I should become subject to the workers' compensation provisions of Section
� /n 370 of e Labor CodMIthwithomply with those provisions.
Datea L� -�' Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AWEMPLOY.ER TO CRIMINAL PENALTIES 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 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 th/an1'cte'01a`ws`,el`ating
)tad ate that the above information is correct. I agree to comply with all
city a d county ordinances to building construction, and hereby authorize representatives
oft}Ss coun%ty toenterupoabove-mentioned grope 'sec ' n purposes.
Datel � ! oS ature (Applicant or Agent):
Application Number . . . . . 09-00001133
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 278.00
Plan Check Fee
180.70
Issue Date . . . .
Valuation . . .
. 28500
Expiration Date . . 4/26/10
Qty Unit Charge Per
Extension
BASE FEE
252.00
4.00 6.5000 THOU BLDG 25,001-50,000
26.00
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Special Notes and Comments
------------
POOL (SPA & EQUIPMENT PREVIOUSLY
PERMITTED).
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 278.00
.00 .00
278.00
Plan Check Total 180.70
.00 .00
180.70
Other Fee Total 1.00
.00 .00
1.00
Grand Total 459.70
.00 .00
459.70
LQPERMIT
AM�
Bin #
City of La. Quinta
Building&` Safety Vvision
Box '1504; 78-495 Calle Tampico
La Quinta,,.CA 92253 - (760) 777-7012
BuildingTermit Application and Va.cking Sheet
Permit #P.O.
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Project Address: lit'
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Owner's Name: .
A. P. Number:
Address: --7 g iY _SS ,
Legal Description:
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Address: (%D;Z-
Project Description:
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State Lic. #: X ()Z /
City Lie.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
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struction TY P Occupancy:
State to Lic. #
ProJ 'e ct tYPe �c , i rcle one • New e Add'n Alter Repair air Dem 0
Name of Contact Person: a
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Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: LQ C) . JjJ Z •
Estimated Value of Project: zb em -
APPLICANT: DO NOT WRITE`BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
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
2nd 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:-
3" 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
TotalPermit Fees
12/02/2009 13:46 FAX 7607767585 AZURE POOLS. & SPAS
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la 00 1 /00 1
Bin #
:
City. of La Quinta
Building &r Safety Division "
P.:O: Box 1504;'78-495.Calle Tampico
La iQuinta, CA 911253, (7.,60)'777-7012
Building Perrmit Application and.Teacking Sheet
Permlc #
Project Address: f ,
Owner`s Name:'
A. P. Number:
Address:
Legal Description.
Contractor: t
-City, ST, Zip_ / J
Telephone:
Address:. k q
Project Description:
City, ST, Zip: h
"telephone:-1(1�7..
State Lia sI : Vi City Lie" 8; .
e .
Arch., Engr., Designer:
Addross:
City, ST. Zip:
Telephone;J4 t9 .
Statc Lie. N:
6olistructidnT . ype:kyjo ' Occupancy:
Projoct type (citt o one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq• Ft.;
# Stories:
#U-aits:
Tel P t�
Telephone # of Contct Pcrson: '
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�--7
Estimated Value of Project•. _ •� . Ir--
<7t
APPLICANT:. DO NOT WRITE BELOW THIS.- LINE
K
Submittal
Iteq'd
Reed '
'TRACXM6
PERMIT FEES
Plan Seta
Plan Cheep Submitted
(.
�:
Item
Amount
Stroetnral Calm
Reviewed, ready.for. corrections
Plan Check Deposit
Truss Coles.
Culled Contact Person
Plan Check Balance
Title 21 Calca.
Pians picked lip.-
Construction
Mod plairi plan
Plans resubioltted -
Mechanical
Grading plan
2'' Review, ready for torreetlonslissue
Electrical
Subcontoctor /let
Called. Contact Person
Plumbic
Grant Deed
Plans picked up
I-LO.A. Approval
' Piansiresabmitted
Crafting
IN HOUSE: -
Review, ready for correction Isiaa
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Nks. Appr
Wte of permit jume
School Fees
L
Total Permit Feet'