08-0497 (RPL)J P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: •_�08-00000497-,`
Property Address: 54940 SECRETARIAT DR
APN: 767-320-999-248 -32879
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 40000
Applicant:
Architect or Engineer:
alA
- ! r
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 CI s: B -C8 -C27 -C ' License No.: 852625
ate: nt
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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 (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 1$500).:
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 workhimselfor 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.).
1 _) 1 am exempt under Sec. , B.&P.C. for this reason
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: �`)fin
Lender's Address: 1"
LQPER4IIT
Owner:
MIKE KELLY
54940 SECRETARIAT DRIV
LA QUINTA,.CA 92253
Contractor:
GAROCCO
74399 HIGHWAY 111, SUI
SOUTH PASADENA, CA 910
(760)341-1245
Lic. No.: 852625
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/25/08
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:
CarrierE� MPT Policy Number EXEMPT
I certify that, in the performance of the work for which this permit is issued, I 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 shA become subject to the workers' compensation provisions of Section
---AA37700�ofthe L r e 1 II forthwith comply with those provisions.
VD plican
WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWR7&', AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO=igNEHUNDRED THOUSAND
DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSAVON, 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 isnot 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 'Iding construction, and hereby authorize representatives
of this ty t e er upon the above-mentioned pr er or i ection purposes.
Kae CO_� ature (Applicant or Agent):
Application Number ... . . . 08-00000497
• Permit . . . . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee 349.50 Plan Check Fee
221.18
Issue Date Valuation . . .
. 40000
Expiration Date 9/21/08
Qty Unit Charge Per
Extension
BASE FEE
252.00
15.00 6.5000 THOU BLDG 25,001-50,000
------=----------------------------------------------------------------------
97.50
Permit . . . MECH POOL
Additional desc .
Permit Fee 26.00 Plan Check.Fee
6.50
Issue Date Valuation . . .
. 0
Expiration Date 9/21/08
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 Fee45.00 Plan Check Fee
11.25
Issue Date . . . . Valuation . .
. 0
Expiration Date 9/21/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL
30.00
Permit . . . PLUMBING
Y
Additional desc .
Permit Fee 33.00 Plan Check Fee
_.8.25
Issue Date . . . . Valuation
0.
Expiration Date 9/21/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 6.0000 EA PLB FIXTURE
12.00
1.100' 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
Application Number . . . . . 08-00000497
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
Fee summary Charged Paid Credited Due
----------------------------------------------------------
'Permit Fee Total 453.50 .00 .00 453.50
Plan Check Total 253.18 .00 00 253.18
Grand Total 706.68 .00 .00 706.68
LQPERnIIT
q CITY OF LA QUINTA, SUB-CONTR CTO/ LIST
JOB ADDRESS PERMIT NUMBER OWNER , �R'�-'� BUILDER
This form shall be Oosted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
M buildin9P ermit For each applicable trade all information requested below must be completed by applicant. "On File" is not an acceptable response.
•
Trade / Classification Contractor :. :.:::.....:
:::.::.::. :......:.:: State;:Contractor .s L�censs . :..
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Workecs.Com erlsaVon;Insurance':°`.' ` >: ';i'>;::::
City Business License€<>
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
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GLAZING
INSULATIOW(C-2) .
SEWAGE DISP (6-44 .
PAINTING (C-33)'.:
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C713)
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Bin #
Qty of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
►'� `
Project Address: — q00 5 �.
Owner's Name: /0//ff—
A. P. Number: G 3297f GT Zff
Address: 5 .-� s'E�• ��
Legal Description: tt �j¢ n o
City, ST, Zip: l,Ll Z�S3
Contractor: iQ;4®Gco z1fe.
Tel �
V
Address: —3q ,�•�6,J �/ � ��
Project Description: Mad POOL fO
City, ST, Zip:
Telephone: 760-5#-
%x:= 4yvi;% < >.::::,;v ::._
State Lic. # : �EJ 2 W Z .�
City Lic. #:
Arch., Engr., Designer: C. 6
Address: 2-01 Al 7—a^l;1 l;1 �.Q .
City, ST, Zip: �4 607
Telephone �•-��QD<tf.>hz;�,.;.,,:;r:•;�,,r'.;•.<.,."�`'��
h
Lie. #:
Name of Contact Person: J'�.lt��C
Construction Type: Occupancy:
ProjState ect type (circle on New Add'n Alter Repair Demo
Sq. Ft : #Stories: # Units:
Telephone # of Contact Person: — —
Estimated Value of Project: 0,000 P
APPLICANT: DO NOT WRITE BELOW THIS LINE
d
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
r•n
-341
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
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.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`" Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval .
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees