13-0478 (RPL)P.6. BbX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
el N
13-00000478
54318 SHOAL CREEK
775-060-006- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000
Architect or E 7
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 Business and Professionals Code, and my License is in full force and effect.
License Class: C53 License No.: 979450, �r
Dater Contractor: C41U ��►(A
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).:
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 ofprovingthat he or she did not build or
improve for the purpose of sale.).
(_ I 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.).
(_) 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:
BEH PROPERTIES
P.O. BOX 10389
PALM DESERT, CA
92255
(760)272-46.91
FFo
Contractor:
CALIFORNIA POOL MASTER
71974 VISTA DEL RIO
RANCHO MIRAGE, CA 9227
(760)275-9779
Lic. No.: 979450
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/18/13
JUN 2� 2013 ,
CITY OF 1.A L INYA
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 XEMPT 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 1 should become subject to the workers' compensation provisions of Section
of the Labor Code, I shall forthwith comply with those provisions."moiDate: )/,700
Applicant: l.�T�..l Fc�2nfrA ��IOZ- 065-1 �.s.
WARNING: AILURE 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, ANWATTORNEY'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 oinission_ 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 con ction, and hereby authorize representatives
of this county to enter upon the above-mentioned pro e f i ction purposes.
Date l Signature (Applicant or Agent).
LQPERMIT
Application Number . . . 13-00000478
Permit BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 207.00 Plan Check Fee
134.55
Issue Date . . . . Valuation
20000
Expiration Date 10/15/13
Qty Unit Charge Per
Extension
BASE FEE
45.00
18.00 9.0000 THOU BLDG 2,001-25,000
162.00
----------------------------------------------------------------------------
Permit MECH POOL
Additional desc .
Permit Fee . . 24.00 Plan Check Fee
6.00
Issue Date Valuation . . .
. 0
Expiration Date 10/15/i3
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 10/15/13
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 10/15/13
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
----------------------------------------------------------------------------
Special Notes ,and Comments
POOL/SPA COOKING ISLAND(GAS LINE
LQPERMIT
LQPERMIT
Application Number . . . . 13-00000478
----------------------------------------------------------------------------
Special Notes and Comments
• ONLY)95' X 211POLY GAS LINE.ALARMS AND
BARRIERS REQUIRED TO BE INSTALLED AT
PRE -PLASTER INSPECTION. 2010 CALIFORNIA
BUILDING CODE.
--------------------------------------------------------=-------------------
Other Fees . . . . . . . . . BLDG'STDS ADMIN (SB1473).
1.00
Fee summary Charged Paid
Credited
Due
Permit Fee Total 303.00 .00
00
303.00
Plan Check Total 158.55 .00
.00
158.55
'Other Fee Total 1.00 .00
.00
.1.00
-Grand Total 462.55 00
.00
462.55
LQPERMIT
BIn.#
City. of.LA Qulhta
Butiding a Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Applicatlon and Tracking Sheet
Permit # .
�j
ProjectAddtess: l vl\�ti1� CR �.
Owner's Name:. (` S LL
A. P. Number.
Address: R 0, Boy, 1058q
Legal Description:
City, ST, Zip: iSn i�� CA 92255
Contractor. lxl L �,j i POOL* 1"l J
(P0
Telephone:�760 - 2W-kl (0 n
Address:? ( _9 -7 Lt V%S. GL 1Qk o.
Project Description:
City, ST, Zip: CV{Q C q22-70
12"(,o" 5 v I h{Nil JC,2(&LAPA
Telephone: -760.2-75'.9-7-2
Q® ItJ6 TSLAtJ KS. L146 • OowState
Lie. # : q-7 9 L(S-0 City Lic, #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo,
State Lic. #:
Name of Contact Person: �4•t
Sq. Ft.:
#Stories:
# Unit;;:
Telephone # of Contact Person:_760 _W75- q
Estimated Value of Project: SDI0 O
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACMG PERMiT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cities.
Reviewed, ready for corrections Plan Check Deposit, .
TY•uss Calcs,
Called Contact Person Plan Check Balance,
Title 24 Cates,
Plans picked up Construction
Flood plain plan
Plans resubmitted Mecharilcal
Grading plan
2'' Review, ready for correctiousfissue Electrical
Subcoatactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.L
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''` Review; ready for corrections/issue Developer Impact Fee
Planning Approval _
Called Contact Person A.LP.P.
y
Pub. Wks. Appr -
Date of permit issue
School Fees
CIU 11 r
0 rm
13U1LDINU ata rmit F
/�'1r'1—nv
FOR CONSTRUCTION
L 8Y
i�
CITY OF LA QUINTA'SUB-CONTRACTOR LIST 400C
JOB ADDRESS � - J �t-��11- C�"� PERMIT NUMBER OWNER M4 PP -0 p&Q"R L) BUILDER CiLUF0�1A �
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 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.
;... .
fication ..:.
de Classi Contractor :::
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t te..0 ntractor.s. License. , :
:...
:.: : Workeis.Com ensation;Insu�ance: `.::. ::.:.< :;:.:
City Biis riess License::.
-Trade
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(FormatVaries)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12) AJA� �TiC� A6ESP4n(E9
A "C5
L7YgoSO �
Li `� 1
045�� f J� fL
1(70000 1 61PJ12)
10/0 '/
1(o7357
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CONCRETE (Q -B)'_ A QA j,1J 0 (s X%
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FRAMING :(C-5)
STRUCT: STEEL (C-51) p,� �(LO �fV� .
Ir
4.
I1
MASONRY (C-29)
PLUMBING 1C-361 l.-1 Fb 1
—7qc
p
LATH; PLASTER (C=35)
DRYWALL (C-9) .:..:
HVAC (C-20)'
ELECTRICAL. (C=10) :... ,�L �` *
:SHEET METAL (C43) `
FCOO�RING
GLAZING (C-17)
INSULATION -.'(C-2).:.:: .
SEWAGE DISP I0-0
PAINTING (C=33)
CERAMIC TILE (C-54)
I
CABINETS (C-6)
FENCING (C-13)
{
LANDSCAPING (C=27).
POOL (C-531 Q1.A Mr'IFGt,� Coe l T BION
C
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