10-0300 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
110-00000300="
81297 CANTOR CT
764-280-999-184 -300236-
REMODEL - RESIDENTIAL
MEDIUM HIGH DENSITY RES
352
Architect or Engineer:
P/
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTO 'S DECLARATION
I hereby affirm under penalty of perjury that am licensed under pr visions of Chapter 9 (commencing with
Section 7000) of Division 3 of the BusinffsVnd Professionals 4od and my License is in full force and effect.
LicenseLlass: C13-053 III Lic.nse o.: 935936
OWNUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exe t 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 70001 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 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. , BAP.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
Owner:
FARRELL
81297 CANTOR COURT
LA QUINTA, CA 92253
Contractor:
CLASSIC POOLS & SPAS
79461 AVENUE 40TH
BERMUDA DUNES, CA 92
(760)413-4867
Lic. No.: 935936
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/08/10
D � �
aPR 2 2G10
13
C:TY OF LA t dl N—M
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 per it is issued. My workers' compensation
insurance carrier and policy number are:
Carrier NATIONAL INS Policy Number 20 090117388
_ 1 certify that, in the performa ce of the work for which is ermit is issued, I shall not employ any
person in any mann so to become subject to th w rkers' compensation laws of California,
and agree that, if I oul become subject to the w rke s' compensation provisions of Section
700 of the Labor o I shall forthwith c ly itch hose provisions.
!, r
vAp ' ant:
WARNING: FAIL URE WORKE ' CO ,SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTI AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). IN ADDITION TO THE C 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 relat to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of t4u,4
ion beco es null and void if rk is not commenced
within 180 days from date of isuch per it, or cessation of k for 180 days will subject
permit to cancellation.
I certify that I have read this application and se bov information is orre . I agree to comply with all
city and cou y ordinances and state laws reldi nstruction, an here y authorize representatives
of this coun to nter upon thea ve-mentioy for i spection pur oses.I /U Sig re (Applicant or A
Application Number . . . . . 10-00000300
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation . . .
. 0
Expiration Date 10/05/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3:0000 EA PLB GAS PIPE 1-4 OUTLETS
-----------------------------------------=----------------------------------
_
3.00
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 15.00 Plan Check Fee
.00
Issue Date . . . . Valuation
352
Expiration Date 10/05/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
-----------------------------------------------=----------------------------
Special Notes and Comments
30 L.F. GAS LINE TO FIREPIT, 12 L.F. 4'
A/C WALL ENCLOSURE, 10 L.F. 4- EQUIPMENT
ENCLOSURE, BOTH CITY STANDARD AND
COURTESY INSPECTION FOR FOOTINGS AT BBQ
& FIREPIT. INCLUDED BONDING GRIE-
INSPECTION FOR CONCRETE. 2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 33.00 .00 .00
33.00
Plan Check Total 4.50 .00 .00
4.50
Other Fee Total 1.50 .00 .00
1.50
Grand Total 39.00 .00 .00
39.00
r
LQPERMIT
Bin #
Cit/ Of La Quinta
Building &r 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:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:0(J
VA
Telephone:
Address:
Project Description:
1
City, ST, Zip: L
30lI (� t l `
Telephone:
``%>rs•:.,x , ? <::?Frf;'i;� k:
hi: 'i:$Ct:;iS {$:!!: L`{::• 4i � ii::i$F�$$'i•$$::{v •:: i
L\ e• U✓IC
State Lic. # : 1
City Lic. #.-
7 r
I v or✓l �
Cr /'
Arch., Engr., Designer:
Address:
L
City., ST, Zip:
Telephone:
State Lic. #:
RX ~vk
w><`:s:;•:. �:�.��:'�'�. z•
. r:Y:°<,s,<,�::slh•'gi.�:;'�cs��ii�.f::i.y`\y=q1
' '$"'> `"r`' "''`' S$'s %"`"' `'>
;$${{YrY%�YH.:$:f:in4i::i': �i'�?�'
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:
Estimated Value of Project: ' 6f C-)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Catcs.
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
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
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
i
Total Permit Fees