07-1458 (RPL)Ir
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
IC 07`-00001458
Property Address:
78 O8 CARNES> CIR.
APN:
604-223-011-54 -23268 -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
15000
T4'!t 4 4 Q"
Applicant: Architect or Engineer:
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 Business and Professionals Code, and my License is in full force and effect.
License CJass4 C53 License No.: 841981
te:' �.r"Ai
OWNER -BUILDER DECLARATION
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 ($5001.:
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 i ithin
one year of completion, the owner -builder will have the burden of proving that he or sh not build r
improve for the purpose of sale.).
(_ 1 1, as owner of the property, am exclusively contracting with licensed contra , ct ( c.
7044, Business and Professions Code: The Contractors' State L' e ® o an wn f
property who builds or improves thereon, and who contra r the ) i contractor(s) Iii en
pursuant to the Contractors' State License Law.). 1 i\a
(_ I I am exempt under Sec. , B.&P.C. for this reaso \�
Date:
Owner:
CONSTRUCTION LI
I hereby affirm under penalty of perjury that there is a construction
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
the DBrforman6e- of the
Owner:
VALDEZ RESIDENCE
78-680 CARNES CIR.
LA QUINTA, CA 92253
(
Contractor:
A & R COMPLETE POOL SERVICE
P.O. BOX 103
LA QUINTA, CA 92247
(760)346-0256
Lic. No.: 841981
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/16/07
-—----—--------—--7—-------------—-------------
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.
_ 1 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 EXEMPT Policy Number EXEMPT
n/ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
v` 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
3700 of the LabV&WP, I shall forth4h comply with those provisions.
atecant:
WARNING: FAILURE 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 ab a information is correct. I agree to comply with all
city and county ordinances ands laws relating buildi onstruction nd hereby au rize representatives
of this my to enter upon above•mentioned ropert f r ' spectio rposes.
115'4
ate: nature (Applicant or Agen
Application Number . . . . . 07-00001458
Permit . . ..
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
162.00 Plan Check Fee
105.30
Issue Date . . . .
Valuation . . .
. 15000
Expiration Date . .
11/12/07
Qty Unit Charge
Per
Extension
BASE FEE
45.00
13.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
117.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
11/12/07
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 . .
11/12/07
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
33.00 Plan Check Fee
8.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
11/12/07
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
REMODEL POOL, ADD ON RAISED SPA, RAISED
LQPERMIT
Application Number . . . . .
07-00001458
----------------------------------------------------------------------------
Special Notes and Comments
BOND BEAM,RELOCATE EQUIPMENT TO
ON
WALL. ALARMS/BARRIERS SHALL BE
IN PLACE
AT PRE -PLASTER INSPECTION.
Fee summary Charged
---------------------------
Paid
Credited
Due
Permit Fee'Total 266.00
----------
.00
--------------------
.00
266.00
-Plan Check Total 131.30
.00
.00
131.30
Grand Total 397.30
.00
.00
397.30
r. w
LQPERMIT
Bin#
City of La Quinta
Building & 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: gO
Owner's Name: q0,
A. P. Number: i
Address: –1'9 LpCi'I/c� Car
Legal Description: "" V-'
City, ST, Zip: C 3
Contractor: (�j ��-� (�
Telephone: —
"
Address: l� 3
Project Description:
City, ST, Zip: � OA •�'1ZZ4�1
S +I$ 0 ✓Z
Telephone. –1 –t)5 0�Miz,�
OFm
[�
State Lie. #":
CityLic. #:
4-0 O Q w
Arch., Engr., Designer:
Address: ,
��
City, ST, Zip:
Telephone:
Construction Type:fh Occupancy:
State Lie. #:"'
Project type (circle one): New Add' Alter epair Demo
Name of Contact Person: 'Pow
Sq. Ft.:
# Stories:
I # Units:
Telephone # of Contact Person:
Estimated Value of Project: j 5 00 O
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
'Ir 7
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction J
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" 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
'
Total Permit Fees
iki ai
Raised Bond Beam
1 +1B"
Ar1r1 nn cna r icarl 1R" {
—201211
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION j
8Y I
_ Q 7
5'mit�j +: 3
161611 (b
APPROVED BY CO•"v,1vi' ?MITE DEVELOPMENT D:.PARTIMEt1Re
BY Z -- --
DATE 5'1�1-D1��-+�
EXHIBIT , E 2 1�U .2& �.►4 l`�U 6IY1� 6
CASE NO. �-�-0 M• 5 4s o nl 3 V
0.
l d� �ttn C�
May 14 07 0.2:15p
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