13-0351 (RPL)P.O. BOX' 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
I
Application Number: 13-00000351
Property Address: 54020 AVENIDA VELASCO
%APN: 774-215-001-1 -000000-
Application description: POOL - RESIDENTIAL
: Property Zoning: COVE RESIDENTIAL
Application valuation: 27229
Applicant(:,. Architect or Engineer!
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BUILDING & SAFETY: DEPARTMENT
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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 Business and Professionals Code, and my License is in full force and effect.
License Class: C53 License No.: 945084
Date: Contractor:
f
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 Cade: 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 (5500).:
i
(_) 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 of 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 contractorls) licensed
pursuant to the Contractors' State License Law.). .
( I I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
1 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:
LQPI--RA71T
Owner:
LARRY & LILLIAN FR EASE
LA QUINTA, CA 92253
(503)516-3451
FR -r -
Contractor:
AMERICAN HERITAGEO
PO BOX 11996
PALM DESERT, CA 9 255
(760)340-2588
Lic. No.: 945084
VOICE (760) 777-7012
FAX (760) -777-7011
INSPECTIONS (760) 777-7153
Date: 3/25/13
a
MAR 2013
�ORPORA
oF LA r' NAN E DEP 1.A
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
1 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
Cperson in any manner so as to become.subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
~Date: , Applicant: ,
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$ 100,000). 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 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 certify 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 authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Da`e Signature (Applicant or Agent):
Application Number -
- . - . 13-00000351
Permit . . .
MECH POOL
Additional desc
-
_
Permit.Fee
24.00_ Plan Check
Fee
6.00
Issue.Date.
Valuation
0
Expiration Date
9/21/13
Qty . Unit Charge
Per
Extension
BASE FEE
15,.00
1.00, 9:0000.EA
MECH.FURNACE <=.100K
9.00
•Permit . .
ELEC POOL PERMIT-RES
Additional desc ...
Permit Fee
45.00 Plan Check
Fee
11.25
Issue Date
Valuation
. . .
. 0
Expiration Date '.
9/21/13
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 . . . .
27.00. Plan Check
Fee
6.75
Issue Date . . . .
Valuation
. . . .
0
.- Expiration Date
9/21/13 ,
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
WALL/FENCE PERMIT
Additional,desc .
Permit Fee
19:00 Plan Check
Fee
.00
Issue Date
Valuation'
671
Expiration Date
9/21/13
Qty. Unit Charge
Per
Extension
BASE FEE
15.00
2.00 2.0000
HND BLDG 501-2,000
4.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL AT-REAR YARD-AND
PROPANE TANK WITH
{
• Application Number- 13-00000351
- --
Special Notes and Comments
.31LF OF 5' HIGH BLOCK ENCLOSURE WALL AT
FRONT YARD [ORCO SPEC).TANK ENCLOSURE
' LOCATION TO COMPLY WITH CITY BUILDING
+. AND LQ MUNICIPAL CODES'. PRECISION
"CONCRETE BLOCK SHALL' BE COVERED WITH
STUCCO, PAINT, OR TEXTURED COATING WHERE
VISIBLE FROM OUTSIDE THE PROPERTY.
ALARMS AND BARRIERS REQUIRED TO BE
r INSTALLED AT PRE -PLASTER INSPECTION.
2010 CALIFORNIA BUILDING CODES.
March 25, 2013 3:18:13 PM AORTEGA
n Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total ♦ 115.00 .00 .00 115.00
Plan Check Total 24.•00 .00 .00. 24.00
ti Grand .Total 139.00 .00 .r 00 _139.00
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City of La Quints
MUM 8r Safety DWon
P.O Box 1504,78-495 Calle Tampico
4.Quinta, CA 92253 -:(760) 777-7012
Building Permit Applicationa^nd Tracking Sheet
Permit #
Pmject Address: 5469_0 ANi t k 60, V I OLS C.CJ. Owner's Name:. 1— Yii e L ar ' r _i k 1 k sin
A. P. Number. Address:SqO20 Ave -ea &C
Legal Description: City, ST, Zip: La U't P -%+CA 012 2 j
Contractor.hhff OQ l Telephone: -6 l (,' ,,L( S/• , ....
z> :
Address: 'PO G (p Project Description:
City, ST, Zip: �a `tel �ecS e� \i O_2_Q;;
Telephone:
State Lic. # : a #,
Arch., Engr., Designer eYl 1 chi O TI l
Address: 77-7767, j— ii Ch -1 (30
City., ST, Zip:
Telephone: 7 Q ^ Construction Type; . panty: .
State Lie. #: Project type (circle one ew Add'n Alter Repair Demo
Name of Contact Person: 1�C ' Sq. FL:
Telephone # of Contact Person: Gb- ") Estimated Value
P 'ect 00
APPLICANT: DO NOT WRITE BELOW THAM
#
Submittal
Plan Sets
Req'd
Reed
TRACKNG
Plan Check submitted Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Caics.
. Called Contact Person
Plan Check Balance
Title 24 Coles.
Plana picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2id Review, ready for corrections/issue
Electrical
Subcontactor Lint
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HO1JSE:-
3"Review; ready for correcdons/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Pees
pp
1 NT/
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CITY OF LA QUINTA
BUILDING SAFETY DEPT.
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FOR CONSTRUCTION
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-LIC# 945004 (760) 340-2588
P.O. 11996 --Palm, Desert, OA 92255
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THIS PROPOSED CONSTRUCTION CONFORMS TO THE CURRENT CODES
2010 CALIFORNIA BUILDING CODE
2010 CALIFORNIA MECHANICAL CODE
2010 CALIFORNIA PLUMBING CODE Q
2010 CALIFORNIA ELECTRICAL COD W Z
2010 CALIFORNIA ENERGY CODE z 0
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