06-2827 (RPL)r�
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: \_ 06-00002827
Property Address: 79942 INDEPENDENCE WY
APN: 604-501-029-2 -24197 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 18000
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
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 Busin nd Professionals Code, nd my License is in full force and effect.
�License Class: 113 nse : 592324
/Date: I / b ontractor:
OW4R-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 ($500).:
() 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, 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
COUGHLIN FRANCES / RUNION LISA
79942 INDEPENDENCE WAY
LA QUINTA, CA 92253
Contractor:
HANGMAN, WES
36-770 PALMDALE
RANCHO MIRAGE, CA 9227
(760)899-1919
Lic. No.: 592324
Date: 8/01/06
tD Q
AUG 012006
CITY OF LA QUINTA
FINANCE DEPT..
-----------------------------------------------
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 EXEMPT Policy Number EXEMPT
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 sho become subject to the rs' compensation provisions of Section
1 3700 of the Labor C e, all forthwith co ly it those provisions.
/ �� i d�0 licant:
WARNING: FAILURE TO SECURE WORKERS' COENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTI AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION T( THE CO T 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. a
I certify that I have read this application and state that t ove information is cor ct. gree to comply with all.
city and county ordinances and state laws relating to b ilding onstruction, d eb aut orize representatives
of th' Urounty to center upon he above-mentioned prop rty for spection po s.
DaI V ignature (Applicant or Agent):
2'
Application Number . . . . . 06-00002827
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
189.00 Plan Check
Fee
122.85
Issue Date . . . .
Valuation
. . .
. 18000
Expiration Date . .
1/28/07
Qty Unit Charge
Per
Extension
BASE FEE
45.00
16.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,OOb
144.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check
Fee
6.50
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date . .
1/28/07
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
1/28/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
--------------- ----------------------------------------------------------------
EA ELEC PRIVATE SWIMMING
POOL
30.00
Permit . . .
PLUMBING
_
Additional desc .
Permit Fee . . . .
33.00 Plan Check
Fee
8.25
Issue Date
Valuation
0
Expiration Date
1/28%07
. 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
r,
LQPERI%IIT
J
LQPE"11T
Application Number . . . . . 06-00002827
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
.Fee summary. Charged Paid Credited Due
----------------------------------------------------------
Permit Fee Total 293.00 .00 .00 293.00
Plan Check Total 148.85 .00 .00 148.85
Grand Total 441.85 .00 .00 441.85
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: 79942 Independence Way
Owner's Name: Fran Coughlin/Lisa Runion
A. P. Number: - .
Address: 79942 Independence Way
Legal Description:
City, ST, Zip: La Quinta CA 92253
Contractor: Country Club Contractors
Telephone:
> :'
Address: 69930 Highway 111 Suite 100
Project Description: Construct Gunite and Plaster Pool
City, ST, Zip: Rancho Mirage, CA 92270
Telephone: 760 899- 1 19
State Lie. # : 881404
City Lie. #;
Arch., Engr., Designer: Flying ButtresS
f% fffy IV •
Address: 73661 State Highway 111it
W AIV
1i
City., ST, Zip: Palm Desert CA 92260
Telephone: 760-77M405 0405
"`<'`.:. •..:;;:;::::.;,::.;;;::.<;::::.;<:.::•:::::.<
1.J
Construction Type: Pool Occupancy:
State Lie. #: 33446
Project a circle one : New ✓Add'
type ) ❑ n❑ Alter❑ Repair ❑Demo ❑
Name of Contact Person: Darren Holm
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 760-899-1919
Estimated Value of Project: gl
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
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 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
r' 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
"'1 q 1,e5
►-R
Patio
II N
35 ft. 0 in.
Tanning Shelf
M
10 ft. 1 in.
CO
7 ft. 1 in.
Existing Patio
Residence
47 ft. 0 in.
New
Patio
14
n
CITY OF LA QUINTA SUB -CONTRACTOR LIST t�
JOB ADDRESS 2 PERMIT NUMBER" OWNER Com - BUILDERCO
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employee are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade / Classification
Contractor :
State:Contractor's License
.:...:... .
Workers Com ensatwnJnsu�ance
Citv. Business License:
Y
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
le.g. State Fund, CalComp)
Policy. Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12) .:
CONCRETE (C -8)t
e
si% 44
Ji•24d•O(o
llo4 ! 73
?• •O
Loi '1,Z
(. •3�
FRAMING'(C-5)
Ilk
STRUCT. STEEL.( C -§fl
O ��yL.^ �_ S
C S
MASONRY (C-29)
PLUMBING (C-36)
LATH, PLASTER (C-35)
MRYWAL (C-9) . .
HVAC, (C -20)..:_:r...
ELECTRICAL(Q40) : . ,
�C�C> L Q
C6
ROOFING'
SHEET METAL (6=43)
FLOORING
GLAZING (C-17)
INSULATIO (C-2) .
SEWAGE DISP, (C-42)
PAINTING (C=33)
CERAMIC TILE.(C-54)��nQ--
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING CG271 °:At
POOL (C-53)
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