08-0829 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tjht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WIJANTA
61426 SAPPHIRE
LA QUINTA, CA
9
VOICE (760) 7774012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/12/08
Contractor: _
Application Number: —08-00000829 1_
Property Address: L
61426 SAPPHIRE" "LN
APN:
764-280-999-84 -300236-
Application description:
POOL - RESIDENTIAL
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
30000
Tjht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WIJANTA
61426 SAPPHIRE
LA QUINTA, CA
9
VOICE (760) 7774012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/12/08
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:
LQPERMrT
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 ordinanc�ature
d state I s relating to buildin ruction, and hereby authorize representatives
of/thi/s�eo y to enter uhe e -mentioned propert r in pe ion purposes.
atD e: (Applicant or Agent):
Contractor: _
Applicant: Architect or Engineer:
TESERRA �� f�g�jNi!!
P.O. sox 1280 CLFlCITYIdIDEPT. '
COACHELLA, CA 92236
(760)398-9222
Lic. No.,: 656128
' LICE SED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I a licensed 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 Busin s an Professionals 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 -
ate: 6 ntractor: - -
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. '
x 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
WNER-BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjur that am exempt from the Contractor's State License Law for the
Carrier SEABRIGHT Policy Number BB1080510
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performan a 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 to become 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
r
and agree that, if I should ecome subject 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 e, shall forthwith 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.:
te: Q icant:
1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
10
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECU RK S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or impr6ves thereon,
SUBJECT AN EMPLOYER TO C NALTIES 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.).
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
- pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
1 ) I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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:
LQPERMrT
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 ordinanc�ature
d state I s relating to buildin ruction, and hereby authorize representatives
of/thi/s�eo y to enter uhe e -mentioned propert r in pe ion purposes.
atD e: (Applicant or Agent):
'Application Number
08-00000.829
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . .
284.50.. Plan Check Fee
184.93 .
Issue Date . . . .
Valuation
29680
Expiration Date
11/08/08
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
11/08/08
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
11/08/08 .
Qty Unit Charge
Per
Extension
BASE FEE.
15.00
1.00 30.0000
7 ----------------------------------------------------------------------
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
11/08/08
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
Permit . . . . . . WALL/FENCE PERMIT
LQPERMIT
Application Number . . . . . 08-00000829
Permit WALL/FENCE PERMIT
Additional desc .
Permit.Fee 15.00 Plan Check Fee
.00
Issue Date Valuation.
320
Expiration Date 11/•08/08
Qty. Unit Charge Per
Extension
BASE FEE
15.00
---------------------------------------------------------------
Special Notes and Comments
POOL/SPA, 20 L.F. 4' EQUIPMENT WALL,
CITY STANDARD. ALARMS/BARRIERS SHALL BE
IN PLACE AT PRE -PLASTER INSPECTION.
Fee summary Charged Paid. Credited
Due
Permit Fee Total 403.50 .00 .00
403.50
Plan Check Total 210.93 .00 .00
2.10.93
Grand Total 614.43 .00 .00
614.43
LQPERMIT
i
Bin #
t
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico -
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
'Permit #
jy�
Project Address:
LA/
Owner's Name: �.
A. P. Number:
Address:
Legal Description:
Contractor: %.Sc�' i2i/}
City, ST, Zip:
'" Ty
Telephone: - �, M -I
'��
IN
Address: 9(,-- 100 A
v•; S-
Project Description:
City, ST, Zip: ,E
_
`-
Ci4 ZZ3 io
OO L L^
Telephone:
State Lic. #: , S
Arch., Engr., Designer:
� Iffis
City Lic. #:
Cl
Y 9
1.
2e�
f �'
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair
Sq. Ft.: # Stories: # Units:
Demo
Name of Contact Person: J SSL
Telephone # of Contact Person:
,� /
Estimated Value of Project: 30000
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cal cs.
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 HOUSE:-
'`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
I
r