11-0335 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: ! 11-00000335 "t
Property Address: ~`79973 RANCHO LA QUINTA DR
APN: .649-740-010- - -
Application description: _ WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 300
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
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 License No.: ' 838188
ie.Ll /S / I Co tor: (� �]1��+,o i 3, J'� C
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 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, 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.).
(_) I am exempt under Sec. - , B.AP.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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/05/11
Owner:
DOUG & KAREN MCCOLEMAN
79973 RANCHO LA QUINTA DRIVE
LA QUINTA, CA 92253
Contractor:
C & M POOLS INC APR 0.5 2011
41530 BALACLAVA DRIVE L
BERMUDA DUNES, CA 92203-11 0 CITY OF
(760)360-6254 FIYA' EaUINTA .
Lic. No.: 838188.
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 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.
ate: pplicant: C' I Y f u� IC ('
'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 ($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 isued 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this,eounty to enter upon the ove-mentioned property for insp %cttii►on^purposes.
ate: L% Si ture (Applicant or Agent):c. �. i//
Application Number
. . . . . 11-00000335
Permit . ...
WALL/FENCE PERMIT
Additional desc .
Permit -Fee
15.00 Plan Check
Fee
.00
Issue Date.
Valuation
300
Expiration. Date
10/02/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00.
Special Notes and
Comments
ADD A 12 L.F. 5161'
SCREEN WALL CITY
STANDARD ADJACENT
TO PUTTING GREEN. 2010
CODES.
----------------------------
Other Fees
----------------------------------
. . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid Credited
----------
Due.
-----------------
Permit Fee Total
----------
15.00 .00
00
15.00
Plan Check Total
.00 .00
.00
.00
Other Fee Total
1.00 .00
.00
1.00
Grand.Total
16.00 00
.00
16.00
�y
1
k_.
-0- ELEVATION SPA WITH
+42" RE-CREATED ROCK
WATERFALL
WATERFALL IS 2' OFF
SIDE WALL
CIS �F � QU'INTA
i/S = i FT BUILDING &SAFETY DEPT.
FOR CONSTRUCTION
DATE Jr BY
f1i
R
FIRE PIT -0-
ELEVATION
=PLANTING ARI
BOULDERS TO'
MATCH .
BBQ ISLAND .
uur»
ity of La Qu•
►nta
Building 8L Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
``, La Quinta, CA. 92253 - (760) 777-7012
Building Permit Application and Trackin-aShear
Project Address:
A. P. Number:
Legal Description:
-Contractor: -
Address:
City, ST, Zip:
Telephone:
State Lic. # :
Arch., Engr.; Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Cafes.
Title 24 Cafes.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
V
Lic. #.-
APPLICANT: DO NOT
'd Recd I 'I
EPlan Check submittcv
Reviewed, reE
Called Conta
Plans picked up
Plans resubmitted
2°" Review, ready for
Called Contact Persoi
Plans picked up
Plans resubmitted.
'n° Review, ready for c
Called Contact Persor
Date of permit issue
9
Owner=s Name: v
t—
p
Address::,q
Pity, -ST, Zip:
,j
Telepho_n
`"•"'
Project Description:
Construction Type:
Occupancy:
'.
Project type (circle one):
New Add'n Alter Repair Demo
:;Sq.:Ft.: #
Stories: �#Units:
=timatdYalue-6f Project: D
—
ice—•
WRITE BELOW THIS LINE
RACKING
PERMIT FEES
Amount
orrections
osit
nce
=Electrical
:orrections/issue
Plumbing
S.M.1.
Grading
orrections/issue
Developer Impact Fee
A.I.P.P.
[Total Permit Fees
9