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09-0911 (RPL)P.O. BOX 1504 f1�/ 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ---------------------- -------------------------- LICENSED T ' DECLARATION I hereby affirm under penalty of peri that I am ' ens u ro isions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bust ss an rof io , and my License is in full force and effect. License s C , 10, 27, 2 i se No.: 656128 Date: ntractor: R- UILDER DECLARATION I hereby affirm under penalty of perjury tha exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business an 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 ($5001.: 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 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 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 VOICE (760) 777-7012 FAX' (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/27/09 Owner: HAMMOND„� 81300 CANTOR COURT Dk) LA QUINTA, CA 92253 t: 012Q09 Contractor: TESERRA P.O. BOX 1280 A COACHELLA, CA 92236 (760)398-9222 Lic. No.: 656128 ----------------------------------------------- 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 B131080510 I certify that, in the performaKES rk f hich this permit is issued, I shall not employ any person in any manner so ale to a workers' compensation laws of California, and agree that, if I tt a orkers' compensation provisions of Section 00 of the Labor e, I y with those provisions. ate: 1 pplicant: WARNING: FAIL RE TO SECURE W KEION VERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PND Cl ES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION T F 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 2. Any permit issued as a result of this appofli t tion beco s null and void if work is not commenced within 180 days from date of issuance f such permit, cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that he above infor a ' is rrect. I agree to comply with all city and county ordinances and state laws relating to b ding constr n, d hereby authorize representatives of this cou toe ter upon the above-mentioned propert for in ctio urposes. j . Xt : ignature (Applicant or Agent): Application Number: 09-00000911 -- _ Property'Address: 81300 CANTOR CT APN: 764-280-999-186 -300236- Application description: POOL - RESIDENTIAL Property Zoning: MEDIUM HIGH DENSITY RES Application valuation: 20000 Applicant: Architect or Engineer: M ---------------------- -------------------------- LICENSED T ' DECLARATION I hereby affirm under penalty of peri that I am ' ens u ro isions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bust ss an rof io , and my License is in full force and effect. License s C , 10, 27, 2 i se No.: 656128 Date: ntractor: R- UILDER DECLARATION I hereby affirm under penalty of perjury tha exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business an 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 ($5001.: 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 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 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 VOICE (760) 777-7012 FAX' (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/27/09 Owner: HAMMOND„� 81300 CANTOR COURT Dk) LA QUINTA, CA 92253 t: 012Q09 Contractor: TESERRA P.O. BOX 1280 A COACHELLA, CA 92236 (760)398-9222 Lic. No.: 656128 ----------------------------------------------- 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 B131080510 I certify that, in the performaKES rk f hich this permit is issued, I shall not employ any person in any manner so ale to a workers' compensation laws of California, and agree that, if I tt a orkers' compensation provisions of Section 00 of the Labor e, I y with those provisions. ate: 1 pplicant: WARNING: FAIL RE TO SECURE W KEION VERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PND Cl ES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION T F 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 2. Any permit issued as a result of this appofli t tion beco s null and void if work is not commenced within 180 days from date of issuance f such permit, cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that he above infor a ' is rrect. I agree to comply with all city and county ordinances and state laws relating to b ding constr n, d hereby authorize representatives of this cou toe ter upon the above-mentioned propert for in ctio urposes. j . Xt : ignature (Applicant or Agent): Application Number . . . . . 09-00000911 Permit . . . ELEC POOL PERMIT -RES Additional desc . Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date Valuation . . . . 0 Expiration Date 2/23/10 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 ---------------------------------------------------------------------------- Permit . . . Additional desc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . BLDG POOL PERMIT 207.00 2/23/10 Plan Check Fee . . 134.55 Valuation . . . . 20000 Qty Unit Charge Per Extension BASE FEE 45.00 18.00 9.0000 THOU BLDG 2,001-25,000 162.00 ---------------------------------------------------------------------------- Permit . . . PLUMBING Additional desc . Permit Fee 33.00 Plan Check Fee 8.25 Issue Date . Valuation . . . . 0 Expiration Date 2/23/10 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 (NO HEATER), GFI & GAS STUB -OUT FOR FUTURE 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 285.00 .00 .00 285.00 Plan Check Total. 154.05 .00 .00 154.05 LQPERMIT J LQPERMIT Application Number Other Fee Total Grand Total 09-00000911 1.00 .00 .00 1.00 440.05 .00 .00 440.05 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 #�,� �l �a Project Address:to ean&t C Owner's Name: m A. P. Number: Z01- r f Address: ,—?�o Legal Description: L City, ST, Zip: Contractor:% S' Telephone: •ra kx4 ' ' Address: CIA -r �� 71l Project Description: City, ST, Zip: Z , S Telephone: State Lic. # :S 17i City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: �..-µ _ Construction Type: Occupancy: State Lic. #: Project type (circle one): Nei Add'n Alter Repair Demo Name of Contact Person: c� — Sq. Ft.: # Stories: # Units: Telephone # of Contact Person:(70650-- U7_ Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Ree'd TRACKING PERMIT FEES Plan Sets Plan Check submitted SI �Lf Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Energy Cates. 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:- 3" 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 - �� _ U.PECYFYCATIONe. rofi r •r] SET >t 7 miss yJaFA[E NE5A aF laU^n a� 31RA n.La A710NB TIL s �AAM.i.+ y'a ye/ 7 [ .'1.W Rr 11 F1— MFEr1.AE t=i a 1,Y4 ReIALM e1�N I 4.Y IQOr�L Ye.1 Aim . bait �L49 �rl£ aC,,m MED l.wu _ yay5l fY:aS 7XY. -/.dam=y ,�Ifa1ifEbLI _ �4[] WaLmo.ITZI TIM BEOKYHO If/- w�� WR PLP r� EYiL1M111.4T . 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