09-0889 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
('09=00000889 tt
Property Address:
49125 AVENIDAJ FERNANDO
APN:
658-280-014- - -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
30000
Applicant: Architect or En ' eer:
- X -04Z (f
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 C ss: C27-053 License No.: 859417
Date: 2 f ontractor:
OWNER-BUILDE CLARATION
I hereby affirm under penalty of perjury that I am exempt from t ontractor'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 ($500).:
1 1 1, 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.). '
(_) 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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: I_.•
�1�
Lender's Address: �IIl ip1
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/20/09
Owner:
BACKMAN
49125 AVENIDA FERNANDO
LA QUINTA, CA 92253 ` O
Contractor: q� U
AMERICAN LANSCAPE/POOLS OF I<L O
85265 DAMASCUS AVENUE Cluj
COACHELLA, CA 92236
(760) 880-1173
Lic. No.. 859417 ��y� jj
------------------------------
----- - - --- ---
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
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 1890134-08
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 should become subject to the workers' compensation provisions of Section
700 of the Lab e, I sh II forthwi ly with those provisions.
Date: g c-, Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION Co AGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. 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 county enter upon the above-mentioned rty fo�,pection
purposes.
D e�Signature (Applicant or Agent?gyp .
Its-
Application Number . . . . . '09-00000889
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
284.50
Plan Check Fee
184.93
Issue Date . . . .
Valuation . . .
. 30000
.Expiration Date
2/16/10
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
2/16/10
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
2/16/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
----------------------------------------------------------------------------
EA ELEC PRIVATE
SWIMMING POOL
30.00
Permit . . .
PLUMBING
t_
Additional desc . .
Permit Fee
33.00
Plan Check Fee
8.25
Issue Date
Valuation . . .
. 0
Expiration Date
2/16/10
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
1.00 3.0000
EA PLB GAS PIPE
1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS
SHALL BE IN
LQFERn4IT
Application Number . . . . . 09-00000889
----------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. 2007
CODES.
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 388.50 .00 .00 388.50
Plan Check Total 210.93 .00 .00 210.93
Grand Total 599.43 .00 .00 599.43
LQPERAIIT
STREET
curb I curb
ITT
AL AND CAROLE BACKMAN
49-125 AVENIDA FERNANDO
LA QUINTA,CA. 92253
LA QUINTA C.C.
covered patio
TREET.
CITY OF LA C
BUILDING & SAFE
APO%
FOR CONSTRU
UINTA
Y DEPT.
E®
;TION
DA "AQ -0q By 5T
City of La Quinta
Building &r Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
09 Building Permit Application and Tracking Sheet
Project Address: 25A-Il G F-C 2A1-% 0 O :•Owner's Name: e- r-PAA 1- )
A. P. Number:
Address;-'
Legal Description:
Contractor:
City, ST, Zip:
Telephone: �.:• , . ^M
Address:$�Z(o� j�.{�yv\� 5 tom- J 6- Project Description:?60 L,--
City, ST, Zip: q
Telephone: 7 (p 5F d
State Lic. # : �J of [' /
City Lic. C
Arch.; Engr., Designer:
Address:
City, ST, Zip:
Telephone., Tele
p
State Lic. #:
s
'� ��t� .. ��Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
'
-Units:
Name of Contact Person: �c� L=Z_. �Q r`�ry C FC 2-- Sq. Ft.:
# Stories: T#
Telephone # of Contact Person: Estimated Value ofP jest: ?j
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Recd TRACIONG PERMIT FEES
Plan Check submitted Item Amount
Plan Sets
Structural Calcs.
Reviewed, ready for corrections Plan Check Deposit
Truss Cales.
Called Contact Person Plan Check Balance.
Title 24 Calm.
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 correctionstissue Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees