07-0293 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number::
07-00000293
Property Address:
48471 STILLWATER'DR
APN:
658-140-999-124 -29436 -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
32000
Applicant:
1 I'
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT :
Owner:
DR. 'SAM PEREZ
48-471 STILLWATER DR.
LA•QUINTA CA 92253-
(760)343-6887
------------------
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: C27 C53 License No.: (801813
Date: A 6 O7 Contractor: I C nm RA 0- Lam}—t/U
' 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 _) 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. 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 - _
VOICE(760)777-7012 -
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Dater 1/29/07
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 EXEMPT 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 I should become subject to the workers' compensation provisions of Section .
3700 of the labor I shalrthw' awp{y w_ ith t rose provisions.
Date: � 07 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERA UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES U 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 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 b Ming construction, and hereby au horize representatives
of this county to enter upon the above-mentioned pro ert or in ction f¢6 S.
Date: (o -i- Signature (Applicant or Agent):
Contractor:
Architect or Engineer:
VICTORIA LANDSCAPES/WA
,53725 AVENIDA MADERO
LA QUINTA, CA 92253
(760) 77.7-1417
Lic. No.: 801813
------------------
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: C27 C53 License No.: (801813
Date: A 6 O7 Contractor: I C nm RA 0- Lam}—t/U
' 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 _) 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. 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 - _
VOICE(760)777-7012 -
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Dater 1/29/07
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 EXEMPT 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 I should become subject to the workers' compensation provisions of Section .
3700 of the labor I shalrthw' awp{y w_ ith t rose provisions.
Date: � 07 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERA UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES U 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 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 b Ming construction, and hereby au horize representatives
of this county to enter upon the above-mentioned pro ert or in ction f¢6 S.
Date: (o -i- Signature (Applicant or Agent):
LQPERMIT
Application Number 07-00000293
Permit . . . BLDG POOL PERMIT
_ Additional desc -
Permit Fee . . . . 297.50 '' Plan Check
Fee
193.38
Issue Date . . . . Valuation
.
. 32000
Expiration Date 7/28/07
Qty Unit Charge Per
Extension
c
BASE.FEE•
252.00
' 7:00 6.5000 THOU BLDG 25,001-50,000 _
-------------------------------------------
45.50
Permit . . MECH POOL w
Additional desc .
Permit Fee 26.00 Plan Check
Fee.
'6.50
Issue Date Valuation
. . .
. . .. .0
Expiration Date 7/28/07'
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.. 7/28/07
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 7/28/07
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 i-4 OUTLETS
3.00
Special Notes and Comments
POOL, SPA, ALARMS/BARRIERS SHALL BE IN
LQPERMIT
Application Number 07-00000293
-'
------------------- - - -
Special Notes ,and Comments.
--PLACE-AT PRE-PLASTER_INSPECTION._
EQUIPMENT ENCLOSURE NOT INCLUDED.
Fee summary Charged
--------
Paid
Credited
Due
.-----------------
Permit Fee Total 401:50
00'
..0-0
401.50
Plan. Check Total 219.38
00
00
21"9.38
Grand Total 620.88
.00
.00
620.88 -
LQPERMIT
C�-
Lc I, 0 OdC1 I r i J
CITY OF LA QUINTA SUB -CONTRACTOR LIST 2°��
J6 ADDRESS Y�-YZL.-_STZ��u�j4-I�� .�� PERMIT NUMBER _ OWN ER��- `1p 13UILDER��--fit V L::�'t1.I__I rJL
fhis form shall be costed 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 ea;ch applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade / Classification ,
Contractor :•
::.
:.:::::; :;<_ :::::..:. State Contractor s License ..._
� � �� • .� ..��, •�� � � �
•:...,: <:W:oikers Com ehsation lrisurai�ce ��.' `
Cit . B'
y usmess Licenser •:
•
EARTIiWORK (C-12)
Company Name
2 �w�
Classification
(e.g. A, B, C 8)
C
License Number
(xxxxxx)
�/
EAP. Dat'
{xz;.;x/xx)
z If C7
� Carrier Name
Ie.g. State Fund, CalComp)
5�fE �' fJfl
Policy Number Exp. Date
(Format Varies) lxx/xx/xx)
z :. Oe3 7301/1
License Numbe:
(xxxx)
--3 1'D\1' j Y
Exp. Date
(xx/xx/xx)
b-
_
CONCRETE (P-8)
uc� ��Si'�u'
g C-�S
(3�•
%fit Or
�J %ice
-L2 -cp {x}22 5 1 t-7
,, 2 -
FRAMING (C-5)
STRUCT::S7EEL jC 51)NA'PLD�jAt,
6utJCrE
�!
NO
�a
�2c-1-0033730 j o7
ct�o3
1 3
"r
MASONRY (C-29)
�S3
�6
)b7
% jlO7
LWtt2'r
t;A0 %
S .
PLUMBING (C-36)
���JCb►�-r �7
L'�3
(�i .
U(.e �G
5 3 07
LATH: PLASTER (*-35)
pbcx
L 3
6FS�3S
Mg
�1i1 T 1 i-��.
RC1- 3�
a gO
�j0 e
DRYWALL (C-9).... .
HVAC IC -20p...:::..:>
ELECTRICAL. (C-10) ,..
�. tZ(q- W
GS 3
FSO (g'/ 3
I 31 c 7
E iCE✓ r�'1 #� I
� , 3
sf 3 07
SHEET METAL (**-43).
FLOORING (Cr='15):
GLAZING (C-17)`. :::.::::QUINT
INSULATION; (C-2).- � ....
BUILDII
JG & SAF
ETY DEPT.
SEWAGE DISP (C-42) . .
E D
PAINTING (C-33)
CERAMIC TILE (C-54)
DA
BY
CABINETS (0-6)
#
I
FENCING (C-13)
LANDSCAPING ICG27.)
POO L(C-53) G
Vf<C.-pt-( atA 3i oOLS
E5.'j
ii$�c$3C� a
Si�t">� �k�U
�']S`� g
! 0.7 '0
Aja cy.
TA A RE -INSPECTION FEE OF $3c°
CITY OF LA QUIN
BUILDING & SAFWILL BE CHARGED IF THE APPROVED
SAFETY DEPT.
PLANS AND JOB CARD ARE NOT ON
FOR CONSTRUCTION THE SITE FOR A SCHEDULED
INSPECTION.
oAMa !•off ,�'��C EPTLONS!
SPA SET @ +18"
..: spa
play
///Jl1//i M 1 5'
3' pool
-X X X
TANNING SHELF
V lC�TU cA-W) I til C_
S3 72-5- -0 Eg_�D
1-0- e--A-
+18"
i
I
3' 16'0
__a__. a
CHILD SAFETY
FENCE
.:...................
............................ .... ............:.... .............- .
EXISTING PATIO
RESIDENCE
DR. PEREZ
Li OF—y1 l S1'LLL vJ+�,"YL P,
LQ c-4- �12ZS3
Bin #
Permit #
Project Address:' — Lf
A. P. Number:
Contractor: V ie,_7?)124�
Address:) —'725'
City, ST, Zip:
Telephone: 7&z� T77
State Lic. # : �RfD! &/ 3
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Cala.
Truss Cala.
Energy Cala.
Flood plain plan
Grading. plin'
Subcoutactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, 'CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Stru u C7 Owner's Name: 5 �1
Address:
City, ST, Zip: c�
Telephone: 7&,q 3c •3
rn _RQ0 Project Description:
Lic. #:
W
VVA
Total Permit Fees
Construction Type:
Occupancy,:
Project type (circle one): New Add'n Alter Repair Demo
S11 -Al J C17.�_
Sq. Ft.:
# Stories:#
Units:
L O l-7, 3 1
Estimated Value of Project:
<Don `40�
APPLICANT:
DO NOT WRITE BELOW THIS UNE
Reed
IRACMG .
PERMIT FEES
Plan Check submitted
item
0�
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Cheek Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2" Review, ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
Review, ready for. corrections/issue
Developer Impact Fee
Called Contact Person
A.I.P.P.
.Date of permit issue
Total Permit Fees