13-0734 (RPL)• r 1, , .. l Y � r Ti4
4
P.O. BOX 1504 - VOICE (760) 777-7012
78-495 CA LLE TAMPICO ✓ i FAX (760) 777-7011
LA QUINTA;'CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT � INSPECTIONS (760) 777-7153
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
13-00000734
78691 AVENIDA TORRES
770-172-003-160 -000000-
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000
Architect or Engineer:
o-�
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT
I hereby affirm under -penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C53 License No.: 946375
/ � l
Oate:cmu-rr3 Contractor: )U1-10 CS6PFCL K76
C%
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 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 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 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:
LQPERA41T
Owner:
PERALES MIGUEL
78691 AVENIDA
LA QUINTA, CA
(760)000-0000
A'
LA
922
Contractor:
NOGUES, JULIO CES
46625 DESERT VILL
INDIO, CA 92201
(760)397-7699
LiC. No.: 946375
Date: 6/12/13
----------------------------------------------—
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 Code. I shall forthwith comply with those provisions.
Date: %.--I-� Applicant: �`t)t_tp �.GA2 y,,3o6[Jir�
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 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 construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for insp coon purposes.
Date: 6-25_ I3. Signature (Applicant or Agent):
_"Application Number . . . 13=00000734
Permit . . . . POOL 2013
Additional desc .
Permit Fee 178.75 Plan Check
Fee
.00
Issue Date Valuation
0
Expiration Date 12/09/'13
Qty Unit Charge Per
Extension
1:+00 178.7500 EA MISC POOL/SPA
178.75
Notes and Comments
_Special
POOL, SPA, WATERFALL, AND GAS LINE [PER
PLANS ENGINEERED BY DENISE POELTLER)
THIS PERMIT DOES NOT INCLUDE ELECTRICAL
AT BBQ. EQUIPMENT SHALL BE INSTALLED IN
ACCORDANCE WITH MANUFACTURER ,
SPECIFICATIONS. ALARMS AND BARRIERS
REQUIRED TO BE INSTALLED AT PRE -PLASTER
INSPECTION. 2010 CALIFORNIA BUILDING
CODE. POOL, SPA, WATERFALL AND GAS LINE.
-.• Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
PLAN CHECK, POOL
97.24
Fee summary Charged Paid Credited
Due
Permit Fee Total 178.75 .00
.00
178.75
Plan Check Total .00 .00
00
.00
Other Fee Total 98.24 .00
.00
98.24
Grand Total 276.99 .00
.00
276.99
LQPERn+rr
a
Bin. #
Cit}/ Of. 12 Quin to
Building 8T Safety Division '
P.O. Box 1504,78-495 Calle Tampico
1.a.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet.
Permit #
Project Address: �. — �� d L0. ^D
Owner's Name:. �� 1. (HCl_ P . L�
A. P. Number.
Address: 1J _
Legal Description:
City, ST, Zip: L ! NT R 225
Contractor. U 1
Telephone:
Address: r
V 6, f
Project Description: Oot-- s
fiLL
City, ST, Zip: N ltd CA qZ20fS
LIMEL
Telephone: —76
State Lie. # : q `
City Lir #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lie. #:
, ' ' " Construction Type: r, L Occupancy:
,x Project type (circle one): ow Add'n Alter Repair Demo
Name of Contact Person: L, i
CE GAN 0 Sq. Ft : M #Stories:
# Univ:
Telephone # of Contact Person:
cl _A 61 q[EstitnatedValueof Project: v),000
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMLT FEES
Plan Sets
3
Plan Check submitted
Item
Amount
Structural Calm
Reviewed, ready for corrections
A/011
Plan Check Deposit_ .
Truss C21cs.
Called Contact Person
Ptan Check Balance.
Title 24 Calm
Plana reked up
Constmetion
Flood plain pian
Pians resubmitted,
Mechanical
Grading plan
2`' Review, readyY',-,0 sectio issue
Electrical
Subcoutactor List
Called Contact Person '
Plumblog
Grant Deed
Pians picked dp
S hLL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
1i° Review; ready for correctionslissuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
1
�Tota_ermtt Fees1
jf
DATE S<!%
T
,r� - CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS �Iz — GG1 I A&bPPERMIT NUMBER ' OWNER MICVL aVA_VS BUILDER moeV t)&,S
This form shall be posted 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 Dermit. For each aDDlicable trade, all information reauested below must be completed by annlicant_ "On File"-- isnot an accentahle resnonse_ ^
Trade sification Contractor
LtcrseCI
C
tate:ontractos:. .
WorkrCo
.CitY. Busines Lcense::_:..;:
Company Name
Classification
(e.g. A. B. G-8)
License Number
(xxxxxx)
; Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. -Date
(xxlxx/xx)
License Number
(xxxx) .
Exp. Date
(xx/xx/xx)
EARTHWORK (C=121 `.r
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CONCRETE (C-81 .0
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FRAMING IC -5)
STRUCT::STEEL �C-51) _ -- - _ _ _
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MASONRY (6-29)
PLUMBING (C-361
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LATH; PLASTER (C�35)
DRYWALL (C
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76 0
19
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HVAC (C720)''
ELECTRICAL. (C=10)'
ROOFING' (C=39) `: .
:.SHEET ME*AL('C 431:
FLOO:1RING (G�5):
GLAZING (C-17). `
INSULATION(C72) :
SEWAGE DISP: (C-42)
PAINTING (C=33)
CERAMIC TILE (C-54) .UL��C_ N��(fESf
_C�;S- -
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CABINETS (C-6)
FENCING (C-13)
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LANDSCAPING .(G=27).
POOL (C-53)
CITY OF LA O.UINTA. SUB -CONTRACTOR LIST f
JOB ADDRESS _7F —R W_ ckL IU TO tri -PERMIT NUMBER ' OWNER • A BUILDER u Ly .
This form shall be Oosted'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 a or, the voidance
of building permit. For each applicable trade, all information requested below must.be completed by applicant: "On File" is not an acceptable response.
e;:Contractot's. License,:. .. ....r
�
tTrade/Classofkad,onContractor,'
Exp. Date
(xx/xx/xx) ,
'Carrier Name -
(e.g. State Fund, CalComp)
Company Name
Classification
(e.g. A. B, C-8)
'
EARTHWOR.K (P-
FRAMING IC -51 ::
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STRUCT. STEEL (C-51) '
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MASONRY (C-29)
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PLUMBING (C-36)
LATH; .PLASTER (C 35)
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DRYWALL (C-9)
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ROOFING (C=39) *::::..'>
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SHEET.METAI IC -43►
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FLOORING (C6:151;":.. `.
GLAZING (CA 7)
INSULATION (C-2) .
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SEWAGE DISP (C-42) •.
PAINTING (C'33)
CERAMIC TILE (C-54)
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CABINETS (C-6)
FENCING (C-13) `
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LANDSCAPING (C=27).6:6.:6
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e;:Contractot's. License,:. .. ....r
Wo►ke s.Com ensation;tnsurance.°`:; . ';::...
Cit ;Business License : .::
License Number.
(kxxxxx)
Exp. Date
(xx/xx/xx) ,
'Carrier Name -
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
p. Date
(xx/xx/xx)
License Number
(xxxx)
Exp'. Date
(xx/xx/xx)
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