09-1234 (RPL)1
- TA
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: -09-00001234- - Owner:
Property Address: 46282 ROUDEL LN MO GHANEM
APN: 600-041-025- - - 46282 ROUDEL'LANE'
Application description: POOL - RESIDENTIAL LA QUINTA, • CA 92253
Property Zoning: MEDIUM DENSITY RES (
Application valuation:,, 26000
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/03/09
Contractor:
Applicant: Architect or Engineer: LEFT COAST POOL CONCEPTS INC.
74478 HIGHWAY 111, STE.B-279 D
PALM DESERT, CA 92260 O ��0��
(760)567-9007
LiC. No.: 930999 O ��'
1_ v
Qy
LICENSED CONT OR'S DECLARATION WORKER'S COMPENSATION DEC ATION
I hereby affirm under penalty of perjury that I am lice under Coprovisions 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 an of ssionals de, 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: C53 License No.: 930999 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
e'` issued.
ate: —05 ontractor _ 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
OWNER -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 EXEMPT Policy Number EXEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to certify that, in the performance of the work 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 be me subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and a ree that, if I should becom bject 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 3� of the Labor Code ,.l s f 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 �/J ,
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: e: pplicant:
(_ 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 _ 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
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 nerformeA under or nursuant to any permit issued as a result 4f this aoolication,
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 in rmation is correct. I agree to comply with all
city and c unty ordinances and state laws relating to buildin c nst tion, and hereby authorize representatives
of this ul toe�er upon the above-mentioned prop rty f i pct n purposes.
te: ��uire (Applicant or Agent)
d Application Number .
. . . . 09-00001234
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee
258.50 Plan Check
Fee
168.03
_ Issue Date . . .
Valuation
26000
c} Expiration Date
6/01/10
Qty Unit Charge
Per
Extension
BASE FEE
252.00
1.00• 6.5000
----------------------------------------------------------
THOU BLDG 25,001-50,000
-----------------
6.50
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . .
26.00 Plan Check
Fee
6.50
Issue Date.,
Valuation
. . . .
_ 0
Expiration Date
6/01/10
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
6/01/10
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
6/01/10
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.UU 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA, 80 L.F. 2"
GAS LINE STUB OUT
LQPERMIT
Application Number . .•.09-00001234
--------------------
Special Notes and Comments
FOR FUTURE APPROVED APPLIANCE'.
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. 2007 CODES.
--------------------------------------------------=---------------------- --
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 2.00
,Fee summary Charged Paid Credited Due
------------------ ---------- -----
Permit Fee Total 362.50 .0.0 .00 362.50
Plan Check Total 194.03 .00 .00 194.03
Other Fee Total 2.00 .00 .00 2.00
Grand.Total 558.53 00 .00 558.53
LQPERMIT
rJ �"�`�� CITY, OF LA QUINTA SUB -CONTRACTOR tI. T `
B ADDRESS L ICn 2�Z ILL�IJi L ^ PERMIT NUMBER OWNER 1 BUICDERIt� CIY1� + f'
o s d -al -all times In - - o c . Only persons appearing on'this,llst or theiremployees are a
this job. Any changes to this list must tie approved by the Building Division prior to commencement of work. Failure to corc,ply will result in a'stoppage of works an
building ermit. For oach.a plicable trade, all information requestedybelow must be.com luted b. applicant. 'On File' isnot an acceptable riffs" nse.
Trade d`Clauifica(ion ;'; .`,
600u$ctOr
*„ .. %sStatQ4ontractor'i•'Ucenie �9[�ug L Ibl�fiisWmtl cCit .,l
-
Com panyNsme
ClassiBcallon License Number Exp. Date Carrier Name
(e.g.-A. B. C-8) Ixxxxxx) Ixx/xx/xx1 (e:9. State Fund, CiWaril)'
PolicyNungw
(ForinatVaries).
ExpAYate License t
Ixxlxilxx). " (xxa
RTHWDRK IC -•t21
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ONCRETE (C:8)
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.RAMI11!O'IC=51
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TRUCE4TEEL44�TEALIA
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SONRY IC -291
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':PLASTER 1035
FIYWALL (C-9) -
VAC- (C -2o)'• ,
CTRICAL (C-10) _ iJF
1(,Q S � � ►r 5 Zt
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HEFT ME7AL;IC-431
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GLAZING IC 17►° ` =
IN SULATION`.IC,-2) ' ..-
3EliyAGE DI SP: 10=42►
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PAINTING (C-33)
CERAMIC 71LE (C-54)
CABINETS (C-6)
F�NGINO IC -1'31
.ANDSCANNG IC -27)_
-OOL (C-53)
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Bin #
City of La Quinta
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # QJ
Oa
Project Address: i (9- Z J20J-1)i: 1
Owner's Name: —�A--
o T—
A. P. Number:
Address:
Legal Description:
City, ST, Zip: C� �-7--1��j.
Contractor: LS�-� l WVJ s �, WC._ Q�S
Telephone:
Address: z:-1
Project Description:
City, ST, Zip: I,
Telephone: 7%U '5G-7 leo
State Lic. # q IRCity
Lic. #:
Arch., ngr., esigner:
Address:
City, ST, Zip -,W Q klatA
Y� % iLjQ; <�:, �.� j} 4iry'''�wlv,SCL�`y'4:v�'1• �J
Telephone: 0%.
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): ew Add'n Alter Repair Demo
Name of Contact Person: —
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:--�
(�0 56, -7 p6`-7
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
H
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
a
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
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.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
i•
73 ft.
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5 ft.' in.
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35 gal ft. 3 ne�I
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29 ft. in.
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BUILDING & SAFETY DEPT. crass
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