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
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