07-1682 (CP)�r
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-00001682
Property Address:
54500 WEST RESIDENCE CLUB DR
APN:
775-3.90-999-33 -31627 -
Application description:
POOL - COMMERCIAL
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
50000
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
4 4a.Qam&6
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Lhereby affirm under penalty of perjury that I alicensed under provisions of Chapter 9, (commencing with
Section 7000) of Division 3 of the Business and rofessionals Code, and my License is in full force and effect.
License/Cllaasss: C8 C27 C29 License No.: 656128
Date: (G7 Contracto 'Imt�:
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 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 (5500).:
( 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.).
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 contractors) licensed
pursuant to the Contractors' State License Law.).
j ) 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:
NADADOR, LLC
78120 CALLS ESTADO, SUITE 203
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(76.0)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/08/07
J
JUN 1 ? 1007 "
CI O I F/Nau LA of"
------------------------------------------------
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 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 SEABRIGHT olicy Number BB1070510
I certify that, in the performance of a work for which this permit is issued, I shall not employ any
person in any manner so as to bec me subject to the workers' compensation laws of California,
and agree that, if I should become ubject to the workers' compensation provisions of Section
700 of the Labor comply with those provisions.
Date:' Applidant:
WARNING: FAILURE TO SECURE WO KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER -TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
APPLICANT 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 this application and state that the above info ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building construc 'on, and hereby authorize representatives
of this
cou ty t enter upon the above-mentioned propert or 'nsp trio purposes.
Date: Signature (Applicant or Agent):
n
1
Application Number ..
. . . . 07-00001682
Permit" . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
414.50 Plan Check
Fee .
269.43
Issue Date . . .
Valuation
50000
Expiration Date
12/05/07
Qty Unit Charge
Per
Extension
BASE FEE
252.00
25.00 6.5000
--------------------------------------------------------------.--------------
THOU BLDG 25,001-50,000
162.50
Permit . . . .MECH
POOL
Additional desc .
Permit Fee . . . .
48.00 Plan Check
Fee
12.00
Issue Date . . . .
Valuation
. . . .
0
Expiration Date..
12/05/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
3.00 11.0000
EA MECH FURNACE >100K
33..00
Permit
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . .
60.00 Plan Check
Fee
15.00
Issue Date . . . .
Valuation
. . .
.0
Expiration Date
12/05/07
Qty Unit Charge
Per.
Extension
BASE FEE
15.00
1.00 45.0000
EA ELEC PWR APP >100
4.5.00
Permit . .
PLUMBING
Additional desc ...
Permit Fee. .
27.00 Plan Check
Fee
6.75
Issue Date . . . .
Valuation
0.
Expiration Date
12/05/07
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 INST/ALT/REP
3.00'
1:00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
---------------
.3.00
--------------
-----------------------------------------------
Special•Notes and Comments
COMMERCIAL POOL ONLY
PERMIT DOES NOT
LQPER,,IIT
LQPERAUT
Application Number
07-00001682
-----------------------
Special Notes and :Comments
----------------
---------
-------------
---------------
INCLUDE FENCES OR
EQUIPMENT WALL
Fee summary
Charged
--------------------
Paid
Credited.
--------------------
Due
-----------------
Permit Fee Total
549.50
.00.
.0.0
.549.50
Plan Check Total
303.18
.00
.00
303.18
Grand Total
852.68
.00
.00
852.68
Bin #
City of La Quints .
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico -
La Quinta, CA 92253 - (760) 777-7012:
Building Permit Application and Tracking Sheet
Permit
7UP
Project Address:* j j0O W ) � ^ 6
Owner's Name: N PbyA'00 L -L
A. P. Number:
Address:
f
Legal Description:
Contractor:
City, ST, Zip:
Telephone: IM_'
�..,z —u ,
Address: • 0 OX 2,5(-,'
Project Description: ,
City, ST, Zip: Col -1-C1 z LLL 7,ZS
[44 fL
O
Telephone:�
tee.
State Lic. # : 5(p (2
City Lic. #:
Arch., Engr., Designer:
Address: -
City, ST, Zip:
Telephone:'
`'��
_ �. � �
=
Construction Type: Occupancy:
N�"� p y:
State Lic. #:
. Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: JSP 1 , N ,4tJDC_Z
Sq. Ft.: a &3
# Stories:
# Units:
Telephone # of Contact Person: � O 2 -02
Estimated Value of Project: Do(!)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING .
PERMPI• FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading,plan
2n' Review, ready for correctionsue
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
cr
COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES
i.
SUPPLEMENTAL REPORT TO SAN. FORM # F DATE_
SUBJECT Ce PERMIT NO.
ADDRESS -'trj02 �A/
REMARKS:
INSPECTOR k4m,-7,
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DEH -SAN -118 (Rev 81021 Distribution: WHITE—Office: CANARY—Owner: PINK—Office