08-0973 (RPL)P.O. BOX 1504
't e
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
e
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
L 8-Q0.000973
60299 POINSETTIA PL
764-270-999-90 .-300232-
POOL - RESIDENTIAL
MEDIUM HIGH DENSITY RES
25000
Architect or Engineer:
to
i- -- - - - - - - - - - - - - - - - - - - - - - - - - - -
ED CONTRACTOR'S DECLARATION
licensed under provisions of Chapter 9 (commencing with
r�ofg�sionals Code, and my License is in full force and effect..
J Z�j.icense No.: 658996
l` OWNER- BUILDER DECLARATION
I hereby ffirm under penalty of perjury that I �.Zssi.ns
xempt fromthe Contractor's State License Law for the
following reason (Sec: 7031.5, Business and Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair astructure, 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.).
(_) 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:
BRAGG
60299 POINSETTIA PLACE
LA QUINTA, CA 92253
FFD
Contractor:
FAMILY POOLS CONSTR
P O BOX 283
LA QUINTA, CA 92247
(760)564-3655
Lic. No.: 658996
VOICE (760) 777-7012 .
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/09/08
Lr v U
80
10-18611
ITY OF L.A QUINTA .
------------------
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 worke s' compensation insurance, as required by Section 3700 of the Labor
Code, for the perfo=e, f e work for which this permit is issued. My workers' compensation
insurance carrier and polic n ber are:
Carrier STATE FUND Policy ofiiber 1344032-8'
I certify that, in the perfOrman a of work for which this permit is issued, I shall not employ any
erso4 in any manner so a ecome subject to the workers' compensation laws of California,
d�ree that, if I sho e�stubiect to the workers' compensation provisions of Section
FhY' of the Labor f .`l�Y/'.ith comply with those provisions.
F LURE TO SECURE WOVE' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
AN PLOYER TO CRIMINAL PE ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Buildingand 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 re!su1Jofwffis 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 emplo s for any act or omission related to the work being
performed under or following issuance of t is rmit.
2. Any permit issued as a result of this applic ion ecom/null and void if work is not commenced
within 180 days from date of issuance of ch er , or cessation of work for 180 days will subject
pto cancellation.
I certify hI'L
readthis application and state that a e information is correct. I -agree to comply with all
city an ccntinances and state laws relating t ui in onstru tion, and hereby authorize representatives
of this uter upon,,P(e above-mentione rop i9s cti purposes.
(Applicant or Agent):
-Application Number . . . . 08-00000973
Permit
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
252.00 Plan Check Fee
163.80
Issue Date . . . .
Valuation . . .
. 25000
Expiration Date
12/06/08
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 Plan Check Fee
6.50
Issue Date
Valuation
0
Expiration Date
12/06/08
Qty Unit Charge
Per.
Extension -
BASE FEE
15.00
1.00 11.0000
----------------------------------------------------------------------------
EA MECH FURNACE >10OK
11.00
Permit. . . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation
0
Expiration Date
12/06/08
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
12/06/08
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. ALARMS/BARRIERS SHALL BE IN '.
LQPERMIT - .
Application Number . . 08-00000973
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 356.00 .00 .00 356.00
Plan Check Total 189.80 .00 .00 189.80
Grand Total 545.80 .00 .00 545.80
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CITY OF IA QUINTA
BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRUCTION
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Bin #
City of La Quinta
Building 8r 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
q
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: t4" ,:; S3 .
Contractor: /- 2g
Tele
Telephone:
Address: j
Project Description:
City, ST, Zip:
Telephone:
State Lie. # : Lla ��j7
City Lie. M.
Arch., Engr., Designer:
Address:
City, ST, Zip:
f}}"r{, ;.: t•'. •\•, n:"tiv:'fes-,1 J".�;3 {,�::
Telephone: �.;-�.,::;;;�,{.�.:a�.v>::�f<}:{•::,{.:;�;s.
}:•:.,:c.,�•}zs f.;}:.x�a3>�<>si;% �:?:
�z�»t<s ws� Vic:` ,� <><`:�:.r �.��::::;• �».::}>.,
State Lie. #
Name of Contact Person:
type: e: Occ anc
uP Y:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: #Units:
# of Contact Person: — Jr3
�Telephone
Estimated Value of Project: -ACJ d . 6^
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
'Submittal
Req'd
Recd
TRACIMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" 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