10-0762 (RPL)P.O. BOX 1504
78495 CALLE TAMPICO
LA' QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
It 10-00060762
52202 SHINING STAR IN
767-200-999-52 -312022-
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
18000
Tit!v44Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
HECTOR ACOSTA
52-202 'SHINING STAR LANE
LA QUINTA, CA 92253
(760)777-9920 ,
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/16/10
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: License No.:
Date: Contractor:
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 Coder 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. Anyviolation 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 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.). "
(_) Ia�m exempt under Sec. , B.&P.C. for this reason
ate: 9 r [c O a-
—alp -
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: ii A
LQPERMIT
------------------
WORKER'S COMPENSATION DECLARATION
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, Cade, 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 - - - - - - - - - - - - - - - - - - --- -- Policy NumberAx -
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 should become �w� �th ers' compensation provisions of Section(7r 3700, of the La t Code, I sha G those provisions.
'oopate: ` (`� 11 cant:
WARNING: FAIL 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 ($.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 Ouinta, 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 informa • is correct. I agree to comply with all
city and county ordinances ands a laws relating to building const io and hereby authorize representatives
of thisJc�-o/Ju/n�ty /t/��reXS*ature
above-mentioned property for ' ecti put
te: `� l t r' l7�Applicant or Agent):
Contractor:
Architect or, Engineer:Ownerun
;I •i j
j
c;IT �+O.9 U� WL'i1WfA
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: License No.:
Date: Contractor:
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 Coder 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. Anyviolation 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 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.). "
(_) Ia�m exempt under Sec. , B.&P.C. for this reason
ate: 9 r [c O a-
—alp -
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: ii A
LQPERMIT
------------------
WORKER'S COMPENSATION DECLARATION
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, Cade, 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 - - - - - - - - - - - - - - - - - - --- -- Policy NumberAx -
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 should become �w� �th ers' compensation provisions of Section(7r 3700, of the La t Code, I sha G those provisions.
'oopate: ` (`� 11 cant:
WARNING: FAIL 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 ($.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 Ouinta, 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 informa • is correct. I agree to comply with all
city and county ordinances ands a laws relating to building const io and hereby authorize representatives
of thisJc�-o/Ju/n�ty /t/��reXS*ature
above-mentioned property for ' ecti put
te: `� l t r' l7�Applicant or Agent):
Application Number
10-00000762
Permit
BLDG POOL.PERMIT
Additional desc .
Permit Fee
189.0.0 Plan Check Fee
-:122.85
Issue Date . . . .
Valuation . . .
. 18000
Expiration Date
2/12/11
Qty Unit Charge
Per
Extension
BASE FEE
.45.00
16.00• 9.0000
THOU BLDG 2,001-25,000
144.00
Permit
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date
'Valuation
0
Expiration•Date
2/12/11
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
2/12/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
----------------------------------------------------------------------------
EA EIEC PRIVATE SWIMMING POOL
30..00
Permit
PLUMBING
Additional desc .
Permit Fee
33.00 Plan Check Fee
8.25
Issue Date
Valuation
0
Expiration Date
2/12/11,
'
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
s
LQPERMIT
Application Number 10-00000762
Special Notes and
Comments
PLACE AT PRE -PLASTER INSPECTION.
•EQUIPMENT ENCLOSURE NOT INCLULDED.
2007
CODES.
------------------------------------------
Other Fees
BLDG
---------------------------------
STDS ADMIN(SB1473)
1.00
Fee summary
Charged
--------------------
Paid,
Credited
--------------------
Due
-----------------
Permit Fee Total
293.00
.00
.00
293.00
Plan Check Total
148.85
.00
.00'
148.85
Other Fee Total
1.00
.00
.00
1.00
Grand Total
442.85
.00
.00
442.85
P.O. Box 1504
LA QUINTA; CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-70.12
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IWORTANT! NOTICE TO PROPERTY OWNKR
Dear Property Owner.
.Ari. application for a building permit has been submitted in your name listing yourself as the builder of the .property
improvements specified at
,We are .Providing you with an Owner -Builder Acknowledgmen and Information -Verification Form to make you aware sof your
responsibilities and possible risk you may incur by having this permit, issued. in your name as the
Owner -Builder. We will not issue a building permit until yow4ave read, Initialed your understanding of each`p>rovision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute thisMotice
unless you, the property owner, obtain the prior approval of the permitting authority.
QW—OR'S A,CI1RjQM EI)GIV NT ANDNERMCATIONO1~ DWOR MTI"
Dlf2'ECTFONS: Read incl initial' each: statement -&&E ee signify you understand or'ver. efy this information.
r/ 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material-persoiia". I, as
an Owner -Builder, may be held liable and subject to serious. financial risk for any injuries sustained by an Unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property-
__fl2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are.not hiring a licensed Contractor to assume this responsibility..
3. I understand as an "Owner -Builder" I am.the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
1/4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
1/ 5. I understand if I employ or otherwise engage any persons; other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and' contribute to unemployment .
compensation for each "employee." I also understand my failure to abide by these laws maysubject me to serious financial
risk.
V/7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
A. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
financial or personal. igjarias sustained. 6yany subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
V/9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at I-
800-321-CSLB (2752) or www.cslb.ca.gcv for more information about licensed contractors.
_.�610. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and financially responsible for proposed construction activity at the following address:
11. I agree that, as the party legally and fmancially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
_tZi
Bin #
Qty of La Quinta*
Building &r Safety Division
0. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P*
-Iwo
0
Project Address: 52- Zo-2- fz, (4V45'
Owner's Name: —7-
A. P. Number:
Address:
Legal Description:
Contractor: 1)UlAlt4 .4iily,46
City, ST, Zip:
Telephone: 2-96
Address:
Project Description:
City, ST, Zip:
7
ac, %/'O -
Telephone: '76,o - Z-W - 76
State Lic. # City Lic.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
X, ..........
. . . . . . . . . . . . . . . . .
..........
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
a Units:
Telephone # of Contact Person: '*v— 216 - 6
Estimated Value of Project: tDo
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal
Req1d
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.
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2". Review, ready for corrections/issue
Electrical
Subcontactor List'
Called Contact Person •
Plumbing
Grant Deed
Plans picked up
S.M.I.
R.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developei Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
i
CITY OF LA QUINTA'SUB-CONTRACTOR LIST
JOB ADDRESS 9,1 -tea- ,�i.� � (�( PERMIT NUMBER OWNER CSL`(' ( i S BUILDER fAMr --
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 employees are authorized to worl
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 voidanc(
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
r.�.t.. I r_hQ��fMatinn Contractor
:..::...:.:.:.:.:<;<State:ContractoMs Lkettse.. :'<:;. :> :.Yllwkers... nsatiMr:itiSwace:',.:', city Busitles License:;::.
Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date License Number Exp, Date
(e.g. A. B, C-8) (xxxxxx) (xxlxx/xx) (e.g. State Fund, CalComp) (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx)
EARTHWORK (C-12)
CONCRETE IC -8)
FRAMING .(C-5)
STRUCT. STEEL (C -5l )
MASONRY (6-29)
PLUMBING (C-36)
LATH; PLASTER (C-35) a
DRYWALL (C-9)
OyAC (C-20)
ELECTRICAL (C-10)
RQOFING'(C=391:;.::.•:.: � .
"SHEET -METAL -(C' 43)
FLORRING (9-'15):
GLAZING (C-17).'
INSULATION `(C-21
SEWAGE DISP- (C-42)
PAINTING (C=33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27).'
POOL (C-53) TfNL'i0 �'nhO %� T,c,E'. C_ 3 3 3 l I ( 5 -� (-!t ,VS&0V 7 • � �3 �� Z 6 (� I l� �`�'"' l ? !'
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