12-0463 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
�7
Application Number: C12=00000463_)`
Property Address: __,52355 AVENIDA-VELASCO
APN: 773-264-016-5-000000-
Application description: POOL - RESIDENTIAL
Property Zoning: COVE . RESIDENTIAL
Application valuation: 9000
Applicant: Architect or Engineer:
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 Businessa Professionals Code, and my License is in full force and effect. ..
License Clas •qq 8 1 , 27 2 License No.: 656128
ale: 30 / ntractor:
OWNER -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 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.).
(_ 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: A
Lender's Address:
LQPERMIT
Owner:
EMBERS, INC.
5005 E.CALLE SAN RAP
PALM -SPRINGS, CA 922
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
617&1 H
uJ
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
--- ---------------
WORKER'S COMPENSATION DECLARATION
1 4/27/12
I hereby affirm under penalty of perjuryone 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
lissued.
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 E17EREST. NATL IN Policy Number 7600006481121
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 should :come subject to the workers' compensation. provisions of Section
70 of 'he Labor Code, I forthwith comply with those provisions.
et d /?/tbolicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 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 restrictionsset 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, indemnity 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 ab ve information is correct. I agree to comply with all
city and county ordinances and state laws relating to building' o ruction, and hereby authorize representatives
of this count a er upon the above-mentioned property f ' pection.purposes.
e: r `
D Siftnature (Applicant or Agent):
Application Number . . . . . 12-00000463
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee... 108.00 Plan Check Fee
70..20,
Issue Date . '. . Valuation . . .
. 9000
Expiration Date 10/24/12
Qty- Unit Charge Per
Extension
BASE FEE
45.00
7.00 9.0000 THOU BLDG"2,001-25,000
63.00•
Permit ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 45.00 Plan Check Fee .,
11.25
Issue Date- Valuation
0
Expiration Date 10/24/12
-
Qty Uhit'.Charge Per
Extension
BASE FEE
15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL
-----------------------=---------------------------------------.--------------
30.00
Permit . . . PLUMBING
Additional desc .
Permit Fee 27.00 Plan Check Fee
6.75. .
Issue Date Valuation
0
Expiration Date 10/24/1.2
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
----------
Special Notes and Comments
SPOOL. NO HEATER. ALARMS/BARRIERS SHALL
BE IN PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED..2010
CODES.
----------- .------------------------------------------- - -
Other Fees . . . . . . . BLDG•STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid. Credited
Due
Permit Fee Total 180.00 .00 .00
180.00
Plan Check Total 88.20 .00 .00
88.20
Other Fee Total 1.00 .00 .00
1.00
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PN 398-9222 FAX: No. 6961/2098 9255
Builders Of r Exceptional Outddor'Living
Bin #
C1ty Of La Qurnta
Buliding 8r Safety Division
P.O. Box 1504,78-495 Calle Tampico
I•a.Quinta, CA 92253 - (760) 777-7012
Building Permit -Application and Tracking Sheet
Permit #
11
.
Project Address: J 2 3 SS A f.Gt
Owner's Name:.
A. P. N.amber.
Address:
Legal Description:
City, ST, Zip: (:A etlwin (2* �'Z ZS 3
Contactor.
Telep hone: `��xzssss�'
Address: `(/_,00 s
Project Description: zeO
City, ST, Zip::2Z
0
Telephone O 3 f 8 9 Z 2
MA
State Lie. # : City Lic. M.
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone: • •.
.,
-Construction .
type:.Occupancy:
it 7
State Lic. #: r
u
Project type (circle one): Q;D Add'a Alter Repair Demo
.:....
Name of Contact Person: L0 AA Z
Sq. Ft.: # Stories:
# Univ:
Telephone # of Contact Person: Z30 Z3 19
Estimated Value of Project: 000
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Rcq'd
Rec'd
TRACMG
PERMITFEES.
Plan Sets
Plan Check submitted
item
Amount
Structural Celts.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cafes•
Called Contact Person
Plan Check Balance •
Tide 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mecbarilcal
Grading plan
2't Review, ready for correctionsfkssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Great Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'^' Review; ready for correcdonsrissuc
Developer Impact Fee
Planning Approval
Callen Contact Person
AJ-P.P.
Pub: Wks. Appr '
Date of permit issue
School Fees
Total PerFees