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08-1595 (RPL)to P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: C08-00001595 ~ 54215 CANANERO CIR 767-320-999-282 -32879 POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 25000 T4&t 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: . Owner: HOGLUND 54215 CANANERO CIRCLE LA QUINTA, CA 92253 Contractor: D TESERRA P.O. BOX 1280 v COACHELLA, CA 92236 (760)398-9222 Lic. No.: 656128 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/18/08 SEP 4 2 2008 L OF LA QUINTA CENSED ONTRACT 'S DECLARATION WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury that lice ed un rovisions of Chapter 9 (commencing with I _ I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and si od and 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 las C8 7 C29 is N 56128 for by Section 3700 of the Labor Code for the performance of the work for which this permit is ate: � C ractor: 0 LARATION I hereby affirm under penalty of perjury th t I am m tne ontractor s 'T2t'e'L•icense.Law for the following reason (Sec. 7031 .5, Business and P essions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repai y 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 1$5001.: 1 _ 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, 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: P Lr LQPERMIT issued. X 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 Number BB1080510 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any m - is s to c e subject to the workers' compensation laws of California, _- and agree that, i sh uld sub' ct to the workers' compensation provisions of Section MO of the Lab sha i comply with those provisions. WARNING: FAILU9E TO SECURE W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDFAN TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOODE, 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 applic on and state th above form�J+ torr I 'to comply with all city and unty ordinances and s to laws relating to buildin t � `an c authoriz representatives of thi o o eytQy pont above-mentioned property for i oses. D te: Sign re (Applicant or Agent): w Application Number . . . . . 08-00001595 Permit . . . BLDG POOL PERMIT Additional desc . Permit Fee . . . . 252.00 Plan Check Fee 163.80 Issue Date . . . . Valuation . . . . 24870 Expiration Date 3/17/09. Qty Unit Charge Per Extension _ BASE FEE 45.00 23.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 207.00 . Permit . . . MECH POOL Additional desc . . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/17/09 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 3/17/09 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 3/17/09 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 Permit WALL/FENCE PERMIT LQPERMIT Application Number . . . . . 08-00001595 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . .. 15.00 Plan Check Fee .00 Issue Date. . . . . I Valuation . . . . 130 Expiration Date . . 3/17/09 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments POOL/SPA, 6 L.F. 6' EQUIPMENT WALL CITY STANDARD, GRAND EFFECTS FIRE RING (ANSI # Z223.1,•75000 BTU)FOR FIREPIT. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. Fee summary Charged Paid Credited ----------------------------------------------- ---------- Due Permit Fee Total 371.00 .00 .00 371.00 Plan Check Total 189.80 .00 .00 189.80 Grand Total 560.80 .00 .00 560.80 LQPEINIIT s Bin # Permit # (^ City of. La Quints , Building a Safe Division Safety P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: ��/ �'l� Owner's Name: A. P. Number: Cm G ZD Address: Legal Description: Contractor: er rTelephone: City, ST, Zip: Address: b--- Ave �&U Project Desc ' OT City, ST, Zip: e Q0-, `7 L2 17 Telephone: I State Lic. # : Arch., Engr., Designer: 2 City Lic. #: Address: ter` City, ST, Zip: Telephone: State Lic. #: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: (7667-50-071-91 Estimated Value of Project: ©— 2 5 K APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Recd TRACKNG . 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 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan' 2°d Review, ready for correctionsrissue Electrical Subcontactor List Called Contact Person Plumbing Pub, Wks. Appr Date of permit issue School Fees Grading Total Permit Fees d2500D ay- 1