12-0405 (RPL).1
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 112-00000405 -~
Property Address: 81499 JACARANDA CT
APN: 764-280-999-163 -300236-
Application description: POOL - RESIDENTIAL
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 20400
Ta�/
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DAVID MOODY
81499 JACARANDA COURT
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/13/12
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.).
(_) 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. CJ.
Lender's Name:
Lender's Address:
LQPERMIT
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 certity,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 authoriz a esentatives
of thi �c1ou ty toenter up o the above-mentioned property for ' pection purp ses.
at I ignature (Applicant or Agent):
I
f
Contractor: D
'
Applicant: Architect or Engineer:
DESERT OUTDOORS INC
)
79405 HIGHWAY 111, 42fdPC�1 1g�`:
LA QUINTA, CA 92253 iH1 110 91
(760) 399-9600
LiC. No.. 964474
FINk►?1 - -
-------------------------------------------------------------------------------------.------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am 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 Business and 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
Licens la : C 7-053 License No.: 964474
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
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ate: ontracto% .f 11 / y i/ /
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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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier NORGUARD INS- Policy Number DEWC229889
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance 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 as 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
and agree that, if I should become subject to the wor ' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of th Labor Code all forthwith comp) i th a 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 ($500)•:
�te pplicant: _1I,
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
WG: FA URE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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.).
(_ 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.).
(_) 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. CJ.
Lender's Name:
Lender's Address:
LQPERMIT
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 certity,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 authoriz a esentatives
of thi �c1ou ty toenter up o the above-mentioned property for ' pection purp ses.
at I ignature (Applicant or Agent):
LQPERMIT
Application Number
12-00000405
Permit ..
MECH POOL
'
Additional desc .
Permit Fee . .
26.00 Plan Check Fee
6.50
Issue Date . . .
Valuation
0
Expiration Date
10/10/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
-----------------------------------------------------------
EA MECH FURNACE >100K
--------=--------
11.00
Permit . . ..
PLUMBING
Additional desc .
Permit Fee . . . .
27.00 Plan Check Fee
6.75
Issue Date . . .' .
Valuation . . .
. 0
Expiration Date
10/10/12
r Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 6.0000
EA PLB FIXTURE
6.00
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 . . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
216.00 Plan Check Fee
140.40
Issue Date . . .
Valuation . . . .
20400•
Expiration Date
10/10/12
Qty Unit.Charge
Per
Extension
BASE FEE
45.00
19.00 9.0000
- -----------------------------------------------------------------------------
THOU BLDG 2,001-25.,000
171.00
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee
15.00 Plan Check Fee
.00
Issue Date . . . .
Valuation
260
Expiration Date
10/10/12
Qty Unit Charge
Per
Extension
---------------------------------
BASE FEE
------------------------------------------
15.00
Permit . . . ELEC POOL PERMIT -RES
Additional desc .
LQPERMIT
Q
Application Number . . . . . 12-00000405
Permit ELEC POOL PERMIT -RES
Permit Fee, 45.00 Plan Check Fee
11.25
Issue Date . . . . Valuation . . .
. 0
Expiration Date 10/10/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL
30.00
----------------------------------------------------------------------------
Special Notes and Comments
SPA WITH WATERFALL, 12 L.F. 54"
EQUIPMENT ENCLOSURE, CITY
STANDARD.ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION. 2010 `
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 329.00 .00 .00
329.00
-Plan Check Total 164.90 .00 .00
164.90
Other Fee Total 1.00 .Go .00
1.00
Grand Total 494.90 .00 .00
494.90
LQPERMIT
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Qty. Of, 'La Quin td
Building 8E Safety Div[sion
Box 1504,78-495 Calle Tampfco
Ia.Quinta, CA 92253 -:(760) 777-7012
Building Penmit Application and Tracking Sheet
Permit #P.O.
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Project Address: 131 9JA
Owner's Name:. IV I t =V1
A. P. Number.
Address: 2
City, ST, Zip: 1
�:�.. .
Telephone `;
Legal Description:
Contractor: Desert Outdoors
Address: 78-065 Main St. Ste. 205
PtrojectDescription:
City, ST, Zip: La Quinta, Ca. 92253
Telephone: 760-399-9600: f * "
State Lie. # : --c-53 964474 City Lie #,uociU U..
Arch, Engr., Designer: Flying Buttress
Address: • 77725,Enfie1d Ln. Ste. 130
City, ST, Zip: Palm Desert, CA. 92211
Telephone: 760-772.4411 �r
State Lir. #: 33446; .:' w
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Name of Contact Person: ��
'
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo .
Sq. Ft.:
# Stories: nits:
#U
Telephone # of Contact Person:
Estimated Value of Project: 2.:)�. y o0
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACMG
PERMIT FEES
Plan Sets
Pian Check submitted y
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Cates.
Called Contact Person
Pian Check Balance
Title 24 Cal&
Plans picked up
Construction
Flood plain plan
Plans resubmitted.' .
Mechanical
Giading plan
2'" Review, ready for correctionsfissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
» HOUSE:-
'"' Review; ready for correetionslissue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees