10-0484 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000484
Property Address: 79420 SIERRA VISTA.
APN: 604-440-042-42 -27519 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 22800
Applicant:
Architect or Engineer:
OvK
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICEN E ONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I i nsed under provisions of Chapter 9 (commencing with
Section•? 00) of Division 3 of the Busine and r fessionals Code, and my License is in full force and effect.
Licari
C : C53 License No.: 658996
ate ntractor:
0 NER-BUILDER DECLARATION.
I hereby affir under penalty of perjury that am empt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Profe ions 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 1, 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 _ 1 I am exempt under Sec. , BAP.C. for this reason
Date: Owner:
I 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: I IN
Lender's Address:
LQPERMIT
Owner:
LORA LEE STOLZOFF
79420 SIERRA VISTA
LA QUINTA, CA 92253
Contractor:
FAMILY POOLS CONSTRUCTI
P O BOX 283
LA QUINTA, CA 92247
(760)564-3655
Lic- No.: 658996
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153.
Date: 6/07/10
F111010F LA Q .WrA
NCE 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 STATE FUND Poli er 1344032-2009
_ I certify that, in the perfo., once a work for which this permit is issued, I shall not employ any
person in any manner to become subject to the workers' compensation laws of California,
and agree that, if I I become subject to the workers' compensation provisions of Section
I' 3700 of the Lab od I Mall forthwith comply with those provisions.
WARNIN : F%64!ME TO SECURE WO • ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJEC AN EMPLOYER TO CRIMINA PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. IN ADDITION TCJTHE 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
orwhose 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 applicatio becomes null work is not commenced
within 180 days from date of issuance of su pe cessation of work for 180 days will subject
• permit to cancellation.
I certify that I have read this application and sta110,d,
�nsp
formation is correct. I agree to comply with all
city and con r finances and state laws relating tru n, and hereby authorize representatives
of this co y t enter upon the above-mentioned i purposes.
Signature pplicant or Agent):
Application Number . . . 10-00000484
Permit . . BLDG POOL PERMIT
Additional desc .
Permit.Fee 234:00 Plan Check
Fee
152.10
Issue Date Valuation
22800
Expiration Date 12/04/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
21.00 9.0000 THOU BLDG••2,001-25,000
----------------------------------------------------------------------------
189.00
Permit . . . MECH POOL
Permit Fee 26.00 Plan Check
Fee
6.50
Issue Date . . Valuation
. . .
. 0
Expiration Date 12/04/10
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-. 12/04/10
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 12/04/10
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
3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
Special Notes and Comments
"POOL/SPA. ALARMS/BARRIERS SHALL BE IN
LQPERMIT
r
s- Application Number . . . . . 10-00000484
- ----------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
2007
CODES.
-----------------------------------------------------------------------------
Other Fees BLDG
STDS ADMIN
(SB1473)
1.00
Fee summary Charged
Paid
Credited
Due
Permit Fee Total 338.00
.00
.00
338.00
Plan Check Total 178.10
.00
.00
178.10
Other Fee Total 1.00
.00
.00
1.00
-- -- -- ---- _ "Grand -.Total 7-----517-10' --
-
---`00
.00 ....
517.10 ....-.. _ ... _._.. _........... .:.
i
i
LQPERMIT - - -
Bin #
City ®f la Quntaa
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
'
Permit #
1�v
Project Address: f s
Owner's Name
A. P. Number:
Address: c
Legal Description:
City, ST, Zip:
Contractor:
Telephone
% > '»':r>: ''•:::>>:::wv<: „;>>
Address:�)4 A�y
Project DescriptionL S
City, ST, Zip:
Telephone
State Lic.•# :
City Lic. C
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: :
;:
State Lic. #: <<:sz«:«:::`:<:`:•`:f'>%'<:;s:::<::><:::>::::? ;s
Name of Contact Person:Sq.
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Ft.:
# es:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: ('
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Catcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Flood plain plan
Plans picked up
Plans resubmitted
Construction
Mechanical
Grading plan
2°' Review, ready for correctionsrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'd 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
�.r