10-0051 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
10-00000051
81297 CANTOR CT
764-280-999-184 -300236-
POOL - RESIDENTIAL
MEDIUM HIGH DENSITY RES
27000
T,iht 4 4a Q"
Architect or Engineer:
PIA-
LICENSED
1p
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busines and Professionals Code, and my License is in full force and effect.
License Cla : !;9,10,27,2 license No.: 656128
ate: Z S 0 ontractor:
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 ($500).:
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.).
I—) 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: 0 114
LQPERMIT
Owner:
FARRELL
81297 CANTOR COURT
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/25/10
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760) 398-9222 FkJ
n ����"�`
Lic. No.: 656128�1l
AfI 2 6 20 10
i
WORKER'S COMPEN ATION DBel11�i!
I hereby affirm under penalty of perjury one of the following ns:
I have and will maintain a certificate of consent to self -insure o e�sation, as pro ided
for by Section 3700 of the Labor Code, for the performance of the work for whic 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 INS Policy Number BB1100510
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
3 0 of the Labor C e, I shall forthwith comply with those provisions.
8'ate: / ° pplicant: vtC_
WARNING: FA RE 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 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to bui mg construction, and hereby authorize representatives
of thjsWZ
er upon
he above-mentioned grope for inspection purposes.
ate: nature (Applicant or Agent):
Application Number . . . . . 10-00000051
Permit
. . . BLDG POOL PERMIT
Additional
desc . .
Permit Fee
. . . . 265.00
Plan Check Fee
172.25
Issue Date
. . . .
Valuation . . . .
27000
Expiration
Date 7/24/10
Qty Unit Charge Per
Extension
BASE
FEE
252.00
2.00
----------------------------------------------------------------------------
6.5000 THOU BLDG
25,001-50,000
13.00
Permit
. . . MECH POOL
Additional
desc .
Permit Fee
. . . . 26.00
Plan Check Fee
6.50
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date . . 7/24/10
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 7/24/10
Qty
Unit Charge Per
Extension
BASE
FEE
15.00
1.00
---------------------------------------------------------
30.0000 EA ELEC
PRIVATE SWIMMING POOL
t
30..00
. . PLUMBING
Additional
desc .
Permit Fee
33.00
Plan Check Fee
8.25
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date 7/24/10
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
----------------------------------------------------------------------------
Special Notes
and Comments
POOL/SPA,
130 L.F. INCLUDES 1 1/2"
GAS
LQPERMIT
r
47
LQPERMIT
Application Number . . . . . 10-00000051
----------------------------------------------------------------------------
Special Notes and Comments
LINE TO HEATER, PLUS 80 L.F. 1 1/2"
GASLINE TO STUB OUT FOR FUTURE BBQ.
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
Permit Fee Total 369.00
Plan Check Total 198.25
Other Fee Total 1.00
Grand Total 568.25
Paid Credited Due
.00 .00 369.00
.00 .00 198.25
.00 .00 1.00
.00 .00 568.25
Bin #
Permit #
Project Address:
City of La Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: LA GvNrvrrl�- CA I 27—ZS 3
Contractor:/�
S C 2 �-
Telephone:
Address: D
Project Description: o 0 L 10A
City, ST, zip: A C *
z w E
Telephon ?-(. a ,9 P2 2 2
state Lic. # :
. Rte. Z � . ',+. '' � •.
:. ? . : ry'`fr "
city Lic.
�✓L
/-12
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone: Construction T QO an
YPe� 10/1 t- f � Occupancy:
State Lic. #: . • "�;� •. �:^ .Z Project type (circle one): Ne Add'n Alter Repair Demo
Name of Contact Person: o C z Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person o
Z S O 2--Z, 18 Estimated Value of Project: 2 000
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plaits resubmitted
Mechanical
Grading pian
2'! Review, ready for corrcctions/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked op
S.M.T.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctionstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Ll
Total Permit Fees
—- � 1
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