10-0266 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000266
Property Address:
7.9621 CORTEZ LN
APN:
649-051-014-14 -2667 -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
28000
T4&t 4 " 4 Q"
Applicant: Architect or Engineer:
VL A,;
AF
PC" rlpt
c
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury thatl,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 Class_:, C53 License No.:, 841981
ate:" nor:
tre
OWNER -BUILDER DECLARATION
Thereby affirm under penalty of perjury that lam exempt4rom the Contractor's°State Llcense:Law forthe
following reason (Sec. 7031:5, Business and Professions Code:. Any city or county that requires a permit to
construct, alter, improve,demolish, orrepalr any structure, prior to its issuance, also requires theapplicantfor 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 1of'the Business and Professions Code) or
that he,orshe is"exempt therefrom and the basis for the alleged.exemptlon. Any violation of Seaton 7031.5 by
any applicant for .a permit subjects thwapplicant to a civil penaltyof not more than five hundredAollers (8500).-
(_ 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 Lew'does not apply to an:ownerof=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, thebuilding or improvementis:soid within
one year, otcompletion,.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, yam exclusively contracting. with licensed contractors to construct the project (Sec:
7044,.Business and Professions Code: The Contractors' State: License Law does not apply an owner of
propertywho builds or improves thereon,and who contracte,for the projects, with acontractor(s) licensed
pursuant to the Contractors' State License Law.).
d _ 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:
JO NELSON
79621CORTEZ LANE
LA QUINTA, CA 92253
Contractor:
A & R COMPLETE POOL
P.O. BOX 103
LA QUINTA, CA 92247
(760:)272-7349
Lie. No.: 841981
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/30/10
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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 thWLebor 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 EXEMPT. _ Policy Number EXEMPT
I certify that, in the.performance of the work for which this permit is issued, 1 shall not employ any
person* in any manner so as to become subject to the workers' compensation laws of California,
and agree that, it I shoulg become subject to the workers' compensation provisions of Section
3700 of the r Cod 1 s all forthwith co ply with those provisions:
4-440
WARNING: FA U1L RE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (8100,000). IN,ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEE&
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safetyfor a permicsubject to the
conditions.and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each persomat 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 Quints, 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 na: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 thatl have read this application and stateth =the above i formation is correct. I agree to comply with all
city and county ordinances ;and state laws relating .building c t tion, and hereby authorize representatives
of thisc my to enter upon theabove-mentioned operty for io purposes.
Defe: � Sig a (Applicant or Ag
Application Number . . . . . 10-00000266
Permit. . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 2_71.50 Plan Check Fee 176.48
Issue Date . . . Valuation . . . . 28000
Expiration.Date 9/26/10
Qty Unit Charge Per Extension.
BASE FEE 252.00
3.00 6.5000 THOU BLDG 25,001-50,000 19.50
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Permit.MECH POOL
Additional desc
Permit- Fee . . . . 26.00 Plan Check Fee 6.50
Issue .Date . . . . Valuation . . . . 0
Expiration Date 9/26/10
Qty Unit Charge PerExtension
BASE FEE 15.0.0
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 . . 9/26/10
Qty Unit Charge Per Extension
BASE -FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
PermitPLUMBING
Additional'des.c .
Permit Fee . . . 33_.00 Plan Check Fee 8.25
Issue Date . . . . Valuation . . . . U
Expiration Date 9/26/10
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 3.0006 EA PIB GAS PIPE 1-4 OUTLETS 3.00
Special. Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
err
Application Number . . . . . 10-0A000266
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Special Notes and
Comments
- --
--
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
2007.
CODES.
-----------------_-_---------------------------------------------------
Other Fees .
. . . . . . BLDG STDS
ADMIN (SB1473)
2.00
Fee. summary
Charged
Paid
Credited
Due
Permit Fee Total
375.50
.00
.00
375.50
Plan Check Total
202,.48
.00
.00
202.48
Other Fee Total
2.00
.00
.00
.2.00
Grand Total
579.98
.00
.00
579.98
LOM MIT
r=
City of La Quinta
Building at Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 77767012
-Building Permit Application and Tracking Sheet
Permit # n
y�
0,
Project mdtess:` z -
Owners Name JD elso J
A P. Number
-Address-
Legal Description:
City, ST, Zip: 144-- QUA& aR 2Z5
Contractor:. t Z M i 5
Address:. AD jsox b -
Telephone: _ --,- �
Project Description:
City, ST, Zip: (,;a —,9 27-147
Q, J .
.Telephone 0-,2-M-73 9
State Lie. # : q ? City Lic. #:
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lie: #:
Name of Contact. Person: kov V-6,082—
C)nstructionType: slew Occupancy:
Project -type (circle one): �p
n Add' Alter an- Demo
Sq.. FL: #Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project: 2 0. QbO
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING -
PERMIT FEES
Plan Sets
Plan Check submitted
3
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calm.
Called Contsct Person
Plan Check Balance
Energy Cases.
Plans picked up -
Construction
Flood plain plan .
Plans resubmitted
Mechanical
Grading plan
V Review, ready for convetions/issue
Electrical
Subcontactor.lbt
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
ILO.A. Approval °
Plans resubmitted
Grading
W IFFOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
r=
79621 Cortez Ln