07-1077 (SOTB)P.O. BOX 1504_
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07700001077
Property Address: 61282 TOPAZ 'DR.
APN: 764-280-999-156 -300237-
Application description: STRUCTURES OTHER .THAN BUILDINGS
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 2000
Applicant:
C�
Architect or Engineer:
�lA
4
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.
LicenseClass: C53 License No.: 87788400
ractor.��/��
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).:
(_) 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.).
(_ 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 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.). '
�s
Lender's Name:
Lender's Address:
LQPERDiIT -
Owner:
DAN HOLTZMAN
61282 TOPAZ DRIVE
LA QUINTA, CA 92253
Contractor:
J-SKEEN POOLS SPA WA
P.O. BOX 11349
BERMUDA DUNES, CA 92
(760)766-5554
LiC. NO.: 878400
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/10/07
TEb
20
7APR0.2007
CITY OF LA QUINTA
FINANCE DEPT.
- WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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
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_C2de, I shall forthwith comply with those provisions.
WARNING: FAILURE 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 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 isnot 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 �lhis applicati nand state that the bove information is correct. I agree to comply with all
city and county ordinancs and s e lawsrelatng to buil g tructio and hereby authorize representatives
of this co ty to enter uon above-mentioned propert or s ctio purposes.
e. gnature (Applicant or Agent): S
Application Number . . . . 07-00001077
Permit BUILDING PERMIT
Additional desc .
Permit Fee 31.00 Plan Check Fee 20.15.
Issue Date . . . Valuation . . . . .1264
Expiration Date 10/07/07
Qty Unit Charge Per Extension
BASE,FEE 15.00
8.00 2.0000 HND BLDG 501-2,000 16..00
--------------=---------------------------------------------------------=---
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee 18.00 Plan Check Fee 4.50
Issue Date . . . . Valuation 0
Expiration Date 10/07/07
Qty Unit Charge Per Extension
BASE FEE 15.00
4.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 3.00
-
---------------------------------------------------------------------------
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 21.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 736
Expiration Date.. 10/07/07
Qty Unit Charge Per Extension
BASE FEE 15.00
3.00 2.0000 HND BLDG 501-2,000 6.00
----------------------------------------------------------------------------
Special Notes and Comments
BBQ & FIREPIT, 18 L.F. 5- EQUIPMENT
ENCLOSURE, -16 L.F.. 5' ENTRY WALL, BOTH.
ORCO SYSTEM
----------------------------------------------------------------------------
Other Fees . . . . . . . ENERGY.REVIEW FEE 2.02
Fee.summary Charged Paid Credited- Due
-----------------------------------
Permit•Fee Total 70.00 .0.0 .00 70.00
Plan Check Total 24.65 .00 .00 24.65
Other Fee Total 2.02. .00 .00 2.02
Grand Total 96.6.7 .00 .00 96.67
LQPERMIT
Bin #
C[`'l of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampito
La Quinta, CA 92253 - (760) 777-7012
-Building Permit Application and Tracking Sheet
Permit # /��
Project Address` _ tJ r
Owner's Name: A9,4 12 Aq
A. P. Number:
Address:
Legal Description:
City, ST, Zip: I AJ
Contractor: a- S k f V Ll �� 5 PA
Address: y gCC r15A—C,,
Telephone:
Project Description:
City, ST, zip: Qs�w t) �c CA c1 �3
' j� � JtJ
Telephone: - 7,6 6- - 5 S `
CityLic. #:11,0196g
�` ,. isoci 90 J-. 3 7 L.1P
State Lie. # :
Arch., Engr., Designer:
/_� 5 /� • Qr `
l�' A
A AJ
Address:
C'C
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Construction Type: 13jL0 ek Occupancy,:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: % - 7 'mss s
Estimated. Value of Project: `CI O
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACMG .
PERMTT FEES
Plan Sets
Plan Check submitted fj
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Energy Calcs.
Flood plain plan
Plans picked up
Plans resubmitted
Constriction
Mechanical
Grading plan'
2" Review, ready for corrections/issue
Electrical ' .
4. V
Subcontactor. List
Called Contact Person
Plumbing
z
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval '
Plans resubmitted
Grading
IN HOUSE:
R r rfewo ass
Developer Impact Fee
Planning Approval
allell►LJ11VJA
A.LP.P.
Pub. Wks. Appr
ate of p RP
School Fees
R CONSTRUCT#
.
DATE
Total Permit Fees
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V BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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