09-1087 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tilq� 4 XP Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
09-00001087
Property Address:
78405 COYOTE CANYON CT
APN:
770-240-005= - -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
7000
Applicant:
LICENSED C
I hereby affirm under penalty of perjury that I am lice e
Section 7000) of Division 3 of the Business and Pro ss
License Class: B t /
/Date:' Cphtractor:
Architect or Engineer:
rk
(Ond------------------
ATIONter(commencing with
ense is in full force and effect.
566
CLARATION
I hereby affirm under penalty of perjury that I aexempt fror the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and P ofessions Co e: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair a y 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 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 _ 1 1, 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. , 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. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
MICHAEL BALMUTH
78405 COYOTE CANYON CT
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/12/09
Contractor: D n a
MC DERMOTT ENTERPRISES (�
P.O. BOX 163
PALM DESERT, CA 92261 OCT
(760)346-0745 3 2009
Lic. No.: 306566
CITY OF L A QUTAITA I
Flue _
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 1576Q31-2009
I certify that, in the pLso
e oWcp
�hhwi
ermit is issued, I shall not employ any
person in any mano brkers' compensation laws of California,
and agree that, if Icors' compensation provisions of Section
��q�33�700 of the Laborhal h thoseprovisions.
y�v_LApp' ant:�
WARNING: FAILUR 0 SECURE WORK S' OMPENSA ION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL NALTIES AND IVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO HE 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 issuanjsuch, or cessation f work for 180 days will subject
permit to cancellation.
I certify that I have read this application and statefor ti ni c rrect. I agree to comply with all
city and county ordinances and state laws relatingru io , a d ereby authorize representatives
of this co my o enter upon the above-mentioned e io pu es.
Oate: iO' S nature (Applicant or A
Application Number . . 09-00001087
Permit . ..
BLDG POOL. PERMIT
Additional desc .
Permit Fee . . .
.90.00 Plan Check
Fee
58.50
Issue Date
Valuation
. . .
. 7000
Expiration Date
4/10/10
Qty Unit Charge
Per
Extension
BASE FEE
45.00
5.00 9.0000
THOU BLDG 2,001-25,000
45.00
-------------------------------------------------------=---------------
----
Permit
ELEC POOL PERMIT -RES
Additional desc ..
Permit Fee . . . .
45.00 Plan Check
Fee
11.25
Issue Date . .
Valuation
. . .
. 0
Expiration Date
4/10/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 .30.0000
EA ELEC PRIVATE SWIMMING
POOL
30.00 .
----------------------------------------------------------------------------
Special Notes and Comments
ADD TANNING SHELF TO
POOL, RE -TILE,
REPLASTER POOL & SPA,
MOVE LIGHT, AND_
RAISE COPING.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
--------------------
----------
Due'
---------------------------
Permit Fee Total'
135.00 .00
.00
135.00
Plan Check Total
69.75 .00
.00
- 69.75
Other Fee Total
1.00 .00
.00
1.00
Grand Total
205.75 .00
.00
205.75
LQPERMIT
Bin #
City of La Q uin to
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
'
/1
Permit #n 1
Project Address: - h UYl -
Owner's Name: C N 14 (
A. P. Number:
Address: 0 . L16 5— L m G�
Legal Description: Lof Li
City, ST, Zip: 14C` C*i. ZZ V-5
tract r:
Con o .r Yh
Telephone:
P hone•
Address: i v (,03
Project Description:
City, ST, Zip: ny G }, 7-z&
Telephone: O
,.:.:,,.,,.......,..,.,.,:,.
a ' A
�DO S
State Lic. # :
City Lic.
r
Q00
Arch., Engr., Designer:
r
o Or LAA �vfi SlACl
Address:
P
Iq L,0 x I Z W e
City, ST, Zip:
Telephone:
Panc •
Construction ' n TYPe: Occup
Lic. #:
Project circle one): New Add'air
Alter RePState
Demon
Name of Contact Person:�p o � bk
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: - u v . Z �(�
Estimated Value of Project: —710 0,0
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 Calcs.
Called Contact Person
Plan Check Balance
Title 24 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:-
'"' 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