07-0492 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
An I; nn+ -
07-00000492
61427 TOPAZ.DR
764-280-999-13 -300237-
POOL - RESIDENTIAL
MEDIUM HIGH DENSITY RES
25000
Architect or Engineer:
PIP(
-
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 t11BIusinand Professionals Code, and my License is in full force and effect.
LicenseClass: A -C -C8 LicenseNo:: 840210
ct
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 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.).
1 _ 1 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 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:
BRAD & HEYSA RYNO
61427 TOPAZ DRIVE
LA QUINTA, CA 92253
Contractor:
CROCODILE CONSTRUCTION
50660 EISENHOWER DR, #914
LA QUINTA, CA 92253
(760)360-5895
Lic. No.: 840210
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/15/07
----------------------------------------------—
_ 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 STATE FUND Policy Number 1828832-2006.
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 Code, 1 s II hwith comply with those provisions.
ate:
WARNING: FAI URE TO SECURE W KERS' CO SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDIT ON 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 building cons ction, and hereby authorize representatives
of thi ount to enter upon the above-mentioned property for in _tion purposes.
OM<ature (Applicant or Agent):
. 14
Application Number . . . . . 07-00000492
Permit . .
BLDG POOL PERMIT
Additional desc .
Permit Fee
252.00 Plan Check Fee
163.80
Issue Date
Valuation . . .
. 25000
Expiration Date
8/14/07
Qty Unit Charge
Per
Extension
BASE FEE
45.00
23.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001=25,000
207.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date.
Valuation . . .
. 0
Expiration Date
8/14/07
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
8/14/07
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
8/14/07
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 1-4 OUTLETS
3.00
Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
LQPERMIT
Application Number . . . . . 07-00000492
----------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited Due
--- ----- ---------- ---------- ----------
Permit Fee Total 356.00 .00 .00 356.00
Plan Check Total 189.80 .00 .00 189.80
Grand Total 545.80 00 .00 545.80
LQPERMIT
OVA
.k,
Bin #
Total Permit Fees
City of La Quinta
Building U Safety Division
Permit #
P.O. Box 1504, 78-495 Calle Tampico
I
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:' I �7
Ib fqZ Owner's Name: r� 4£ 1F)
A. P. Number:
_
Address: I - t� 6 A -Z ,
Legal Description:
If
r
City, ST, Zip:
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Contractor: r
Telephone: s" (e - (' D
Address: _ I 1 � • `
S Project Description:
City, ST, Zip: rV1'l�
` 9W-� Tt
n
Telephone: IoZ - )?S'- TIC 7 I.� — PO v 7
State Lic. # : ��
City Lic. #:
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic.
Construction Type: Occupancy:
Project hype (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
k Q K'�—
(,
0 .
r' moi• Ft.: : �� # Stories: #Units:
Telephone # of Contact Person:
S OV
Estimated value of Project: Q 6 c)
APPUCANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd
Reed .
TRACKING
Z Pian Sets
PERMIT FEES
Plan Check submitted
Structural Cales.
item Amount .
Reviewed, ready for corrections
Truss Cala.
Plan Check Deposit
Called Contact Person
Energy Calcs.
Plan Check Balance
Plans kicked up
Flood plain plan
Construction
Plans resubmitted
Grading. plan'
Mechanical
2'' Review, ready for correctionstissue
Subcoutae'tor List .
Electrical
Called Contact Person
Grant Deed
Plumbing
Plans picked up
H.O.A. Approval
S.M,L "
Plans resubmitted
IN HOUSE:-
Grading
Review, ready for.corrections/issae Developer Impact Fee
Planning Approval
Called Contact Person
Pub, Wks. Appr
A.I.P.I
Date of permit issue
School Fees
Total Permit Fees