09-0087 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T -i -tit 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 09-00000087
Property Address: 54130 CANANERO CIR
APN: 767-320-999-292 -32879 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 26000
Applicant: Architect or Engineer:
/
-----------------
I hereby affirm under penalty of perjurf that I an
Section 7J00) -Cr Division 3 of the Busk ss and
LicensZ;Y�
Date:.
SIA
I'S DECLARATION
visions of Chapter 9 (commencing with
rand --my License is in full force and effect.
No.: 656128
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perj tha exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Busi ess gWprofessions 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 ($500).:
(_ 1 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.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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:
MILLER
54130 CANANERO CIRCLE
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/05/09
D
U
D
FE 0 9 2009
CITY OF LA QUINTA
WORKER'S COMPENSATION DECLARATION
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 Policy Nu ber BB1080510
I certify that, in the performance of the r fo 'ich�this permit is issued, I shall not employ any
person in any mann as to u to the workers' compensation laws of California,
y /�a d agree that, if should beco j t trkers' compensation provisions of Section
_
/ANhe Lab Code, I sh f i yvith those provisions.
WARNING: FAILURE TO SECURE WORKERS' O PEA
,E COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE LTI SAND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$ 100,000). IN ADDITION TO AE C ST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, lifrER56T, 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, agen I.Qyees for any act or omission related to the work being
performed under or following ssuance of this permit.
2. Any permit issued as a result this application becomes null and void if work is not commenced
within 180 days from date of is rice of such permit, or ce ion of work for 180 days will subject
permit to cancellation. Z
I certify that I have read this application and state tha above)' o n i •o I agree to comply with all
city and county ordinances and state laws relating to buildin u on, ere authorize representatives
of this c_Wty_w_enterypon the above-mentioned property n on ase
(Applicant or Agent):
Application Number . . . . . 09-00000087
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
258.50 Plan Check
Fee
1(58.03
Issue, Date . . . .
Valuation
25870
Expiration Date
8/04/09
Qty Unit Charge
Per
Extension
BASE FEE
252.00
1.00 6.5000
-----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
6.50
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check
Fee
6.50
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
8/04/09'
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
8/04/.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
8/04/09
r
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
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date
Expiration Date .
. . . . 09-00000087
WALL/FENCE PERMIT
15.00 Plan Check Fee .00
Valuation 130
8/04/09
Qty Unit Charge Per
Extension
BASE .FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA, BBQ (ANZI Z223.1), FIREPIT,
6
L:F. 5' EQUIPMENT WALL, CITY STANDARD
&
150 L.F. 1 1/2" GAS LINE.
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION.
------------------------------------------------------------_----------------
Other Fees . . . . . . . . . BLDG STDS
ADMIN (SB1473)
2.00
Fee summary Charged Paid
---------------------------
Credited
Due
----------
Permit Fee Total 377.50
.00
--------------------
.00
377.50
Plan Check Total 194.03
.00
.00
194.03
Other Fee Total 2.00
.00
.00
2.00
Grand Total 573.53
.00
.00
573.53
LQPERMIT
Bin #
City of. La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:.
Owner's Name: I ��
A. P. Number: U 1 � � � 2 Z
Address: . 5�Z")30 C e) C(Wlt�—
Legal Description:.
Contractor: er rTelephone:
City, ST, Zip: f4% - C
Address: b-- ��
Project Description: L
City, ST, Zip: e q ( -! VL2
t.
Telephone: �q2�Z
15- 1hq— �Lvv� ct4A%4Ee_
State Lie. # : 5 2 City Lie. #:
Arch., Engr., Designer:
f 2.� . / ,c ftgc&j
Address:
L s
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lie. #:
Project type (circ le one): New Add'n Alter Repair Demo
Name of Contact Person:FranK,-rNSq.
FL: b457'
# Stories:
#Units:
Telephone # of Contact Person:(7(00 v-- UZ
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACMG .
PERMIT 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
Zed Review, ready for correctionsfissue
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
a600a
i50
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