09-0841 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: C_09-00000841_
Property Address: 81285 CANTOR CT
APN: 764-280-999-183 -300236-
Application description: POOL - RESIDENTIAL
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 10000
Ti -ht 4�Q�w
Applicant: Architect or Engineer:
aIP
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED TOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lice under p visions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Profession de y License is in full force and effect.
Lichen ass: C8, 10, 27, 2 Lice 656128
/D e: ntractor:
O DECLARATION
I hereby affirm under penalty of perjury that I am axe the Contractor's State License L r the
following reason (Sec. 7031 .5, Business and Prof s Code: Any city or county that requires a pe to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant he
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 • 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_ 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:
LQPERIIIIT
Owner:
CAMPBELL
81285 CANTOR
LA QUINTA, CA
COU
92
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/03/09
-----------------------------------------------
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 Policy Number BB1080510
I certify that, in the p ormance of the work f . ch this permit is issued, I shall not employ any
person in any man r as to beco
m jeer to the workers' compensation laws of California,
and agree that, if I sh becom bje t
of the Labor Code, I i
af7 [e: plicant:
WARNING: FAILURE TO SECURE WORKE SP
SUBJECT AN EMPLOYER TO CRIMINAL ALTIES AN
DOLLARS ($100,000). IN ADDITION T HE COST OF C
SECTION 3706 OF THE LABOR CODE, INTEREST, AND A
the workers' compensation provisions of Section
nply with those provisions.
COVERAGE IS UNLAWFUL, AND SHALL
FINES UP TO ONE HUNDRED THOUSAND
?NATION, DAMAGES AS PROVIDED FOR IN
VEY.'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 abov ' formation is correct. 1 agree to comply with all
city and county ordinance ate law ating uildi nstruction, and hereby authorize representatives
of tbi<cou(t7fa1enter u on the above;mentione spection purposes.
Date:
or
Application Number . . . . . 09-00000841
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . 117.00 Plan Check Fee 76.05
Issue Date . . . . Valuation . . . . 10000
Expiration Date 1/30/10
Qty' Unit Charge Per Extension
BASE FEE 45.00
8.00 9.0000 THOU- BLDG 2,001-25,000 72.00
----------------------------------------------------------------------------
Permit . . . . . . MECH POOL
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee 6.5.0
Issue Date . . . . - Valuation. . . . . 0
Expiration Date 1/30/10
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 1/30/10
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 27.00 Plan Check Fee 6.75
Issue Date . . . . Valuation . . 0
Expiration Date 1/30/10
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
SPA ONLY. 15 L.F. GAS LINE FOR FUTURE
LQPERMIT
Application Number . . . . . 09-00000841
----------------------------------------------------------------------------
Special Notes-and Comments
APPROVED APPLIANCE. ALARMS/BARRIERS
SHALL BE IN PLACE AT PRE-PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED. 2007 CODES.
- ----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN
(SB1473)
1.00
Fee summary Charged Paid
---------------------------
Credited
Due
----------
Permit Fee Total 215.00 .00
--------------------
.00
215.00
Plan Check Total 100.55 .00
.00
100.55
Other•Fee Total 1.00 .00
.00
1.00
Grand Total 316.55 .00
.00
316.55
r
LQPERA11T
B'°#
City of. La Quinta .
Building tat Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
0q.
Project Address:7)7C-,5 7;
Owner's Name:
A. P. Number: �Q
Address: r z
Legal Description:
City, ST, Zip:
Contractor: er raTelephone:
_
Address: b--
Project Description: /
City, ST, Zip:L-236
�!
Telephone: , g22a
State Lic. # : 5 Z
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:-+
.
Construction Type: A/W Occupancy:
State Lie. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: ,�t7
# Stories:
# Units:
Telephone # of Contact Person:(766 v— UZ -9 1
Estimated Value of Project: 4
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING.
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
2 d 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:-
3rd 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
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