14-0095 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
SLA QUINTA, CALIFORNIA 92253
Application Number:
14-00000095
Property Address:
53540 DEL GATO DR
APN:
770-370-002- - -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
35000
T4
4&Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
(,901&ftr T4A
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licens d under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pr f ss Code, and my License is in full force and effect.
License Class; C53 Li se No.: 856835
V,Dat� 6 ,y Contractor:
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 (55001.:
(_ 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, 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 I am exempt under Sec. , BAP.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:
CLEARWATER, RONALD
-------------------------------------- -
--�--
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.
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
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1948584-2013
_ I certify that, in the performance the work for which this permit is issued, I shall not employ any
person in any manner so as bInhw'
me su l t to the workers' compensation laws of California,
and agree that, if I sh tomubje t the workers' compensation provisions of Section
/��//►� -CAP of the Labor e I shall h mply with thos ns.
Date: !//TL Applicant:
WARNING: FAILURE TO SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO RIMINAL 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 beta. null and void if work is not commenced
within 180 days from date of issuance of such pe mi[, r cessation of work for 180 days will subject
permit to cancellation. F
I certify that I have read this application and statAtouni
bove inf rmation is correct. I agree to comply with all
city a��n�d/pcouJnt7�o'di nances and state laws relating cons uction, andhereby authorize representatives
of they _ enter upon the above-mentionefor in action purposes.
'Dat tr/'Signature (Applicant or Age
Application Number . . . . . 14-00000095
Permit POOL 2013
Additional desc .
Permit Fee . . . . 178.75 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 7/29/14
Qty Unit Charge Per
Extension
1.00 178.7500 EA MISC POOL/SPA
178.75
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Special Notes and Comments
_ POOL AND SPA AT REAR YARD ONLY [POOL
ENGINEERING INC] THIS PERMIT DOES NOT
INCLUDE EQUIPMENT ENCLOSURE. ALARMS AND
BARRIERS REQUIRED TO BE INSTALLED AT
PRE -PLASTER INSPECTION. 2013 CALIFORNIA
BUILDING CODE.
January 30, 2014 10:18:32 AM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
2.00
PLAN CHECK, POOL
97.24
Fee summary Charged Paid Credited
---------------------------
Due
------------------------------
Permit Fee Total 178.75 .00 .00
178.75
Plan Check Total .00 .00 .00
.00
Other Fee Total 99.24 .00 .00
99.24'
Grand Total 277.99 ..00 .00
277.99
LQPERMIT
Bin #
Qty of La Quinta
Building &r 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: L
TCS' , I/
Owner's Name:
A. P. Number:
Q
)0470
IJ16& C
Address: Lo 7- /o/ f A e rf�dl
71-04-1
Legal Description: �tQtAl
'City, ST, Zip: pejl^j';�
Contractor: JA c, a-TleA,
telephone:
Address: Y V2aW c l f CgA;JC�— 41CI
Project Description C/ 0/
City, ST, Zip:Jd/o
Telephone: -260-77,1`01e,?
•
State Lic.#: CS34769ff'
City Lie. #.-.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
-K,
.........................................
Construction Type: Occupancy:
State Lie. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: GefqU
�hnproY-).
Sq. Ft.:
tories:
# Stories::
# Units:
Telephone kof Contact Person:' ?
Estimated Value of Project: 3s,000
APPLICANT: DO NOT WRITE BELOW THIS LINE
11
Submittal
Reqld
Recd
TRACKING
PERMIT FEES.
Plan Sets
Plan Check submitted
Item
Amount
Structural Caics.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cities.
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 correctio "fiss
Developer Impact Fee
Planning Approval
Called Contact Person. \Xy!
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
jo*