08-1568 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 500:156.8
Property Address: 55990 PINEHURST
APN: 775 -241 -021 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 30000
Applicant:
c&ty/ 4 4 Q"
Architect or Engineer:
4A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
GREG JOHNSON
55990 PINEHURST
LA QUINTA, CA 92253
Contractor:
COMPETITIVE WEST
PO BOX 5865
LA QUINTA, CA 922
(760)625-2512
Lic. No.: 916827
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
w u
CONSTR
SSP 1 92C
CITY OF LA QUINTA
Date: 9/16/08
-----------------------------------------------------------------------'----------`----------------
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 7000)?of Division 3 of the Business 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: , C53 License No.: 916827
_
for by Section 3700 of the Labor Code, for the performance of the work for which this. permit is
issued.
ntractor:
_ 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 I ani exempt from the Contractor'sState License Law for the
Carrier E} EMPT Policy. Number EXEMPT
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 become 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
forthwith comply with those provisions.
3700 of the Lab4WORRS'
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).:
e? 19 0 plicant:
( ) 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
WARNING: FAILURE TO SECUROMPENSATION 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 PENALTIES 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
I _ 1 1, 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 Piofessions 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 this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). -
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I—) 1 am exempt under Sec. B.&P.C. for this 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 construction, and hereby authorize representatives
Lender's Name:
Lender's Address: P Ir
LQPERMIT
of this �6s rater upon the ove-mentioned property f ' _spection purposes
ate: r / 0 Sign re (Applicant or Agent):
Application Number . . . . . 08-00001568
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 284.50 Plan Check Fee 184.93
Issue Date . . . . Valuation . . . . 30000
Expiration Date 3/15/09
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 3/15/09
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 3/15/09
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 . . 3/15/09
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, 190 L.F. 2" GAS RUN FOR FUTURE
LQPERMIT
Application Number . . . . . 08-00001568
----------------------------------------------------------------------------
Special Notes and Comments
APPROVED AND SEPARATELY PERMITTED BBQ &
FIREPIT. ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE EXISTING.
Fee summary Charged
Permit Fee Total 388.50
Plan Check Total 210.93
Grand Total 599.43
LQPERMIT
Paid Credited Due
--- -- ---------
.00 .00 388.50.
.00 .00 210.93
.00 .00 599.43
M
CITY- OF LA QUINT4SOB-CONTRACTOR LIST
0 BUILDER
JOB, ADDRESS PERMIT NUMBER WNER. AebA apt C
This form shall be posted on the job with the Building Inspection Card at A times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Anychangesto 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 voidance
f building permit. For each applicable trade. all information reauested below must be complet6d by annlicant. "On File" is not an accemable response.
Trade I 6assification W.
Contra
dritraii bnse?.
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Workers --Com
W
-BUS,
License: City in
Company Name
Classification
(e.g. A, B, C-8)Format
License Number
(xxxxxx)
'Exp. Date
(xx/xx/xx)
Carder Name Policy Number
(e.g. State Fund, CalComp) ( Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp, Date
(xx/xx/xx)
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PLUMBING (C-36)'
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DRYWALL (C-9)
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ELECTRICAL (Cl 0),
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PAINTING (C -*33)'-:
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CERAMIC TIL . t (C-54)IRU
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FENCING (C-13)
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POOL (C-53)
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Bin #
•
City of La Quinta
Building.& Safety Division
P.O. Box 1.'504, 78-495 Calle Tampico
La Quinta, .CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit'#
Project Address: 575— ClC10 ��� 11V
t,f
Owner's Name: ��� Jo44"o
A. P. Number:
Address:
Legal Description:
Contractor: Co M _L111 S de L CDN
City, ST, Zip: ZA Qty AAA Ca 9 V53 .
Telephone: '760 '%O a- 9 2a
Address: 5965
Project Description:
City, ST, Zip:QUIA'1724 CA- .?2-Z-qg
Awl � c5/°i� . W G'o� 0✓t'
Telephone: 62_5'_- a 512-
l2-
State Lic. #:
State
City Lic. #: IOyf 03
aS%/ No t�Jl1%N
Arch., Engr., Designer:
� k_r.9G• l'
"D
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one):New AM.n Alter Repair Demo
Name of Contact Person: C t'-�R�s- T��sG :
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:Wa _ �clp�
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACIONG,
PERMIT FEES
Plan Sets
Plan Check submitted
g114,
Item
Amount
Structural Calcs.
Reviewed, ready f corrections
4 / t'(p
Q/� fp
Plan Check Deposit
Plan Check Balance
Truss Calcs.
Called Contact Person t:lh2.LJ �1�
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for correctio i ue
Q
7 (j
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 correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Y
4
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CITY OF LA QUiN`i",
BUILDING & SAFETY DE'P
APPROVED'
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