05-1741 (SOTB)l000
Q 0-1
0
BUILDING SAFETY DEPARTMENT
Box 1504 1 . I - - .
(760)7 77-7012
7 CALLE TAMPICO
FAX (760) 77-7-70YI
LA U I t A, CALIFORNIA 922.53 INSPECTION REQUESTS -(760) 7,77-7153
BUILDING PERMIT
p ation N.umber 05-00001741 Date 5/G6/05.
erty Address . . . . . 79675 TOM FAZIO LN N
PN: 766-032-020- 71
Application description, .-.-STRUCTURES�,OTHER THAN BUILDINGS
Property Zoning .. . . .. LOW DEN ' SITY RESIDENTIAL
Application..valuation-.' 2000...
Owner Contractor
--------------------------------- ----------------------------------
HILL ROBERT M CALIFORNIA POOLS & SPAS
79620 TOM FAZIO LANE NORTH WCC: SEABRIGHT INS
-0 BB1050510 0 1-/ d'i 0 6
HOLTVILLE - CA 9.225 WC:
C.SLB: .65,6128 .1:0/3.1/06
CCC: C8 C27- C29 C53
-------------- ---------------------------------------------- ---------------
P. 0' ' Box 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Date: 9 -os
Applicant:
Applicant's Mailing Address:
-(7ON T -ICA C TO IC
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
AIIA
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of pedury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Li ei i force and effect.
License Class
,,45ate 5/7149IF— . Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
U 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 or 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.).
U 1, 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
U I am exempt under Sec. _, BA P.C. for this reason
Date
WORKERS'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 Secti�n 3700 of the Labor Code. for the performance
of the work for which this permit is issued.
_Iha
pve a9d will I t 'in orkers'compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
W workers' ompensation insurance carrie
1&�er HeIl —Policy Number at/vy
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 th . i ould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Applican
AP
WARNING: FAILURE TO SECURE WORKERS'COMPENS N 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.
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.).
Lenders Name
Lender's Address
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 undero'r 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 cancellat n.
:,rmat!,o
I certify that I have read this application and state that the above infi on is ect. I gree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to ter upon e -mentioned property for inspection purposes.
Date 1:51_f1405_ Signature (Applicant or Agent)
- - - - - - - - - - - - - - - - - - - - - - - - - - - I - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Application Number 05-00001741
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Permit .. . . . . . BUILDING PERMIT
Additional desc
Permit Fee . . . . 45.00 Plan Check Fee .29.'25
Issue Date . . . . Valuation . . . . 2000
Expiration Date 11/02/05
Qty Unit Charge Per Extension
BASE FEE 15.00
15.00 2.0000 HND BLDG 501-2,000 30.00
----------------------------------------------------------------------------
Permit . . . . .
. ELEC POOL
Additional.desc
Permit Fee . . .
. 45.00
Issue -Date
FEE-
Expiration Date
11/02/05
PERMIT -RES
Plan Check Fee . . 11.25
Valuation . . . . 0,
Qty Unit Charge
Per
Extension
BASE
FEE-
15.00
30.0000
----------------------------------------------------------------------------
EA ELEC
PRIVATE SWIMMING
POOL
30.00
Permit . . . . ...
PLUMBING
Additional desc
Permit Fee . . . .
21.00
Plan Check
Fee
5.25
Issue Date . . . .
Valuation
. . .
. 0
.Expiration Date
11/02/05
Qty Unit Charge
- Per
Extension
BASE
FEE
15.00�
1.00 6.0000
EA PLB
FIXTURE
6.00
------------------------------------- -----------------------------------------
Special.Notes and Comments
-COURTYARD FOUNTAIN.
----------------------------------------------------------------------------
Other Fees . . . . .
.. . . . . ENERGY
REVIEW FEE
2.93
Fee summary Charge
-----------------
d
Paid Credited
Due
----------
'Permit Fee Total
----------
111.00
-----------
.00
----------
.00�
111.00
Plan Check Total
.45.75
00
.00
45.75
Other Fee Total
2.93
.00
.00
2.93
Grand Total
159.68
.00
.00
159.68
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit. Application and Tracking Sheet
Permit #
mw
Project Address:
�-OWner's Name:
A. P. Number:
Address:
Legal Description:
Contractor: POOLs
City, ST, Zip:
Tele hone:
p
Address: C) Box I -n 0,
Project Description:
City, ST, Zip :CMteh d [a 9 2.9 3 (0
COUgUAW 1--QUIA-414
Telephone:
.. 77
K -7...
z
T1- 7'
State Lic. # 9)
City Lic.
1;11;� :111;oi 11
C
Arch., Engr., Designer:
Address:
11,14 ........ ..
!!j I
City, ST, Zip:
Telephone:
State Lic. #: .
. ............
Co nstruction Type: Occupancy:
Project type (circle one):6;p Add'n Alter Repair Demo
Name of Contact Person:DAN ZS*49;5W-
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact
A
Estimated Value of Proj 6ct:.
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Reqld
Reeld
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan. Check Deposit
Truss CaIcs.
Called Contact Person
Plan Check Balance
Title 24 Calts.
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.L.
H.O.A. Approval
Plans resubmitted
Grading
AN HOUSE--
Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub.Wk.s.Appr
Date of permit issue
School Fees
Total Permit Fees'