12-0206 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
//512-00000206--�
\4880.1__SANf UCAS ST
658-310-001- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
35000
Ta!t 4 XA Q"
Architect or Engineer:
olk
BUILDING & SAFETY DEPARTMENT'
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that Iam 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 Class: C53 0, nse No.: 348768
Date: 3 �Z� � ontractor: '
OWNER -BUILDER DECLARATION
I 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 Icommencing 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 civil penalty of not more than five hundred dollars ($500).:
1 _ 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 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 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—) 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
Owner:
PAGE TOBY C
C/O CANTOR & FITZGERALD
3811 TUTLE CREEK DR NO 16
DALLAS, TX 75219
Contractor: ;U,
WESTERN POOLS
P.O. BOX 5328
LA QUINTA, CA 92248 P�
(760)200-4777
Lic. No.: 348768
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/07/12
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,
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 CNCLD/ST FUND Policy Number 1270996-2012
I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
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 L bor Code, I shall forthwith -comply with those provisions.
a0 te:plicant:
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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this ounty to enter upon the above-mentioned property for i e p os
(Applicant or Agent):
Application Number . . . . . 12-00000206
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 317.00 Plan Check Fee 206.05
Issue Date Valuation . . . . 35000
Expiration Date 9/03/12
Qty Unit Charge Per Extension
BASE FEE 252.00
10.00 6.5000 THOU BLDG 25,001-50,000 65.00
------------------------------------------------ ---------------------------
Permit . . . MECH POOL
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date 9/03/12
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 9/03/12 -
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 9/03/12
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. ALARMS/BARRIERS SHALL BE IN
LQPERMIT
Application Number . . . . . 12-00000206
7 -----------------------------------------------------------------------
Special Notes and
.Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
2010
CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
2.00
Fee summary
-----------------
Charged
--------------------
Paid
Credited
Due
Permit.Fee Total
421.00
.00
--------------------
.00
421.00
Plan Check Total
232.05
.00
.00
232.05
Other Fee Total
2.00
.00
.00
2.00
Grand Total
655.05
.00
00
655.05
LQPERMIT
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Western Pools
78409 Darby Road
Bermuda Dunes, CA. 92203
Toby Page Residence
44 91 /M/c'•�� � K� »`'yip,
48-801 San Lucas Drive
La Quinta, CA. 92253
22_-U__1 n r�
47.8 FG 47.0 TF m . I
CM i
1 47.09 FS
1'.
48.15 TG
45.63 INV 1
48.29 IS -� � •; I .
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a N ti*.47J.
{ 45.8Q INV ► . P J II
XISTING , BLOCK
4 yh�, ` ;• "• •• I I ALL'. TO R N CITY OF LA Q U I N TA
49.7 Tc` BUILDING & SAFETY DEPT.
< q I .528 INV • .
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IN
FOR CONSTRUCTION
6 + 45.56 INV �.
DATIF� .li • IZ. By �T
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® 47.1 EG 46.5 EG
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(47.17 FS)
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! COL- CART PATH: \
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INV -IN OF SLAB
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EX. HEADER
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Bin.
Permit U..
of
Project Add=.:, V -V
-La'.
Oty o* f 'Q uinta
.-BUfk0ng8tS3feiyD1vlsi6n-,
P.O. Box. 1504, 78,4950116 Tampic"o
La -Quinta, CA 92253 -:(760) 777-7012
'Building Pennit.Application 'and Tracking Sheet
0*ncr's Name:.
A. P. Number.
Address:
Legal Description:.
Contractor
Citi. ST, Zip:
Telephone:
Address: 7g q/,6 y IeW
Project Description: -
City,ST,Zip: Rernty
A
004
Telephone: 2-C)o 777
State Lic, #:
City Li(—.. fk-
At ch, &U.. Designer
Address:
City, ST. Zip:
Telephone:
State Lic. M
Construction Type: Occupancy:
Project type (crde one): New Add'n. Alter Repair Demo
Sq. FL: stories: 9 Tirdw
Name of ContactPerson:
Telephone 0 of Contact . Person:
Estimatod Vahm of Project coc
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Reqld
Recld
TRACKING PERMTFMS-
Plan Sets
Plan Check submitted Item Amount
Structural Cala.
Reviewed, ready for corrections Plan Check Deposit.
Truss Cales.
Called Contact Person Plan Check Mance
Mile 24 CalciL
Plans picked up Construction
Flood plain plan
Plans rtsubmifted.'. Mecha"
Grading plan
21! Review, ready for correctionsrissue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up SALL
H.O.A— Approval
Plans resubmitted Grading
IN 111011SE--
3" Review; ready for correctionsilssuc Developer Impact Fee
Planning Approval'
Called . . Contact Person
Pub. Wks. Appr
Date of permit Issue
School Fen