07-2707 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00002707
Property Address: 58117 CARMONA
APN: 764-200-006-9 -316811-
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 30000
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MCHENRY/NORTH RESIDENCE
58-117 CARMONA D
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
OCT 08?GW7
Date: 10/04/07
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LICENSE CONTRACTOR'S DECLARATION
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am I ensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and ofessionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C8 C27 C29 License No.: 656128
i
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: Contractor:
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
L— .-- -
Code, for the performance of the work for which this permit is issued. My workers' compensation
O NER-BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
- Carrier SEABRIGHT Policy Number BB1070510 '
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the 4ork for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior, to its issuance, also requires the applicant for the
person in any manner so as to becomb subject to the workers' compensation laws, of California,
permit to file a sighed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become su ject to the workers' compensation provisions, of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code hall forth ith comply with those provisions.
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.:
Date:Q pplicant:
(_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
F7 '
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WO PENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 contractorls) 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:
LQPERMIT
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 inf rmation is correct. I agree to comply with all
city and county ordinances and state laws relating to buildi cons uction, and hereby authorize representatives
of this county to enter upon the above-mentioned prope f r ins ction purposes.
Date: �gnature (Applicant or Agent):
Application Number . . . . . 07-00002707
Permit
. . . BLDG POOL PERMIT
-
Additional
desc.
Permit Fee
. . . . 284.50
Plan Check
Fee
184.93
Issue Date
. . . .
Valuation
. . . .
30000
Expiration
Date 4/01/08
Qty Unit Charge Per
Extension
BASE
FEE
252.00
5.00
----------------------------------------------------------------------------
6.5000 THOU BLDG
25,001-50,000
32.50
Permit
. . . MECH POOL
Additional
desc .
Permit Fee
26.00
Plan Check
Fee
6.50
Issue Date
Valuation
0
Expiration
Date 4/01/08
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 4/01/08
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
39.00
Plan Check
Fee
9.75
Issue Date
Valuation
. . . .
0
Expiration
Date 4/01/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00
3.00
6.0000 EA PLB
FIXTURE
18.00
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
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Special Notes and Comments
POOL, SPA,
ALARMS/BARRIERS SHALL
BE IN.
_
LQPERMIT
Application Number . . . . . 07-0000.2707
----------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
WATERFEATURE PER APPROVED PLAN ONLY.
EQUIPMENT ENCLOSURE NOT INCLUDED.
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 394.50 .00 .00 394.50
Plan Check Total 212.43 .00 .00 212.43
Grand Total 606.93 .00 .00 606.93
LQPERMIT
Bin #
City ®f La QLI-Inta
School Fees
Building U Safety Division
Total Permit Fees
P.O> Box 1504, 78.495 Calle Tampico
Permit #
l
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: S
Owner's Name; e
A. P. Number:
Address:
Legal Description; � �`%
Q/t/%����Q- City, ST, Zip:
Contractor:
Telephone:
Address: Project Description:
City, ST, Zip:
CA- 7.,3 6 S � ^
Telephone:
State Lic. # : (05;(21City
Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
a Construction Type: Occupancy:
State Lic, #:
p Project type (circle one) ew Add'n Alter Repair Demo
Name of Contact Person: Sq. Ft.: #Stories: T# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd
Ree'd TRACKING PER]SM ;FEES
Plan Sets
Plan Check submitted t 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
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 I40USE:-
3'd 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