07-2514 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T-iht 4 1'wa"
Application Number: 07-00002514
Property Address: 81694 RICOCHET WY
APN: 767-200-999-19 -312021- .
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 30000
Applicant: Architect or Engineer:
-----------------
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 in full force and effect.
License Class: C53 /�r License No.: 878400
Dateyf- / 3-? Contractor: l /Kew t 4__5
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt 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 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 70001 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).:
(_) 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 _ 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:
DOVING RESIDENCE
81-694 RICOCHET WAY
LA QUINTA, CA 92253
Contractor:
SKEEN POOL/
PO BOX 1134
PALM DESERT
(760)766-55
Lic. No.: 8'
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/11/07
-
------------------------- - - - --- ---J -----
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.
_ 1 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 EXEMPT Policy Number EXEMPT
I 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
3700 of the Labor Code, I shall forthwith comply with those provisions.
• ,
Date9`1 ? --? Applicant:-✓VL�.Q_ t7 �"�Gc�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 0100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT.ACKNO W LEDGEMENT
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 Ouinta, 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. 1 agree to comply with all
city and county ordinances and state laws relating to buildin cons uction, and hereby authorize representatives
of this county
to enter upon the above-mentioned property f r ins tion pu oses.
Date:9—/J — / Signature (Applicant or Agent): ��—
Application Number . . . . . 07-00002514
Permit . . .
BLDG POOL•PERMIT
Additional desc .
Permit Fee . . . .
284.50
Plan Check
Fee
184.93
Issue Date . . . .
Valuation
29848
Expiration Date
3/09/08
Qty Unit Charge
Per
Extension
BASE
FEE
252:00
5.00 6.5000
----------------------------------------------------------------------------
THOU BLDG
25,001-50,000
32.50
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00
Plan Check
Fee
6.50
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
3/09/08
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
3/09/08
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
.1.00 30.0000
7 -----------------------------------------------------------------------
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
3/09/08
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
Permit . . . . . . WALL/FENCE PERMIT
LQPERMIT
Application Number . . . . .. 07-00002514
Permit WALL/FENCE PERMIT
' Additional desc .
Permit Fee. . . . . 15.00
Plan Check
Fee
00
Issue Date
Valuation
. . .
. 152
Expiration Date 3/09/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL, SPA, ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION. GAS
STUB FOR FUTURE APPLIANCES. EQUIPMENT
WALL 7 L.F., X 5- HIGH (ORCO DETAIL)
Fee summary Charged Paid
Credited
Due
-------------------------------------
Permit Fee Total 403.50
----------
.00'
----------
.00
403.50
Plan Check Total 210.93
.00
.00
210.93
Grand.Total 614.43
.00
.00
614.43
LQPERMIT
1 ��I�
6l/ yr r r yr L-P%.�avn• a " a7vu-v%JIV a F-VAke 1 VK LIJ 1
ADDRESS U -�o l IC�� N�� �- 4 PERMIT NUMBER OWNEs, r C BUILDER S KAl
This form shall be posted on the' b with the Building Inspection Card at all times in a conspicuous —'�—
l9 9 nsD p ce. .Only persons appearing on this list or their employees are authorized to wo
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will .result in a stoppage of work and/or the voidanc
of building permit. For each applicable trade, all information requested below must be completed by applicant. 'On File* is not an BrcPnt.k1k.
Trade I Classifica{ioo '
Contractor
ontrgctor.oUcaji§e ' W jice�s.Coi
Company Name
Classilication
(e.g. A. B, C-8)
License Number
Ixxxxxx)
Exp: Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalCornp)
EARTHWORK (C-121
CONCRETE (C-6)
STRUCT-`ST
MA50NRY.{C•29)
PLUMBING (C-36)
DRYWALL (C-9) .
HVAti (5:•20)
EL
;$HEFT METAL ( 4)
FLOORING (tj '6):v`
GL•kZING (-- '
INSULATION'.(C-2)
SEWJ QE p)SI?; (G. 42)
PAINT114G IG 33)
CERAMIC-TILEIC-64)^]
[:-SVQ
j 3 f- a,
. X ce.t1 7'
CABINETS IC -61
FENCING (C-13) '
LANDSCAPING (C-27)., •;.
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Com- (� E;
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Bin #�
City of LaQ uinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit.# (%j<
\" \
Project Address: JQ LC o c.l-1J- C-1-1-A-V
Owner's Name: fZ,-d- Zr ,u,44 DC7 Vz'4J
A. P. Number:Address:
Legal Description: Pp� U- S _
Contractor. T—.5 j< i,) Pc cS PA
Address: g I'� : 5
City, ST, Zip: LA w
Telephone:
Project Description:
City, ST, Zip:
-
Telephone: - �-s-
State Lie. # : City Lic. #:
Arch., Engr., Designer:
i�
/Y 'dor /3 R
EFO 1 P W-A LL
Address:L-
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Com° U Occupancy:
Project type (circle one): New A_dd'n Alter Repan Demo
Name of Contact Person: :� AMEke-e
S. Ft:,
#Units:or
Telephone # of Contact Person: 260-2J
--6
Estimated Value of Project
APPLICANT:
DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd -
Reed
TRACMG .
PERMU FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plan'
V Review, ready forcorrectiouslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval'
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctionslrssne
Developer Impact Fee
Planning ApprovalCalled
Contact Person
Ayp p
Pub. Wks. Appr
-Date of permit issue
School Fees
Total Permit Fees
iy2