05-1678 (RPL)uraw, Kumucy
BUILDING & SAFETY DEPARTMENT
P.O.- Box 1504
78-495 CALLE TAMPIC6
-777-701'1
FAX (760)
LA QUINTA, CALIFORNIA 922.53 I*NSPE'C.TION REQUESTS (760) 777-7153
BUILDING PERMIT
A Ay4
i Pal� er . . . . . 105�7_000019791 Date 5/02/05
res
. . . .. . . 55495 TURNBERRY WY
EPT 767 -550 -008. -
pp ication description'. POOL RESIDENTIAL
Property Zoning'. LOW DENSITY RESIDENTIAL
Application'va'.lua,tion . . . . 20000
Owner Contractor
- - - - - - - - - - - - - - - - - - - - - - 7 7 - --- - - - - 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - -
SWC.NORMAN 39 MCINT YRE POOLS & SPAS, INC.
C/O DAVID PEERY WCC:-, STATE FUND
7161 INDIANA AVE WC: 1769111 011:01IQ6
RIVERSIDE, CA 92504, C.SfB: 614�6'11� 09/30/05
CCC:_ C 5 3,
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P.O. Box 1504 VOICE (760) 777-7012
7�495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: JS_ 71? Date: _5
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
U 0 /V 77A�d r— T-0 k
Architect or Engineer's Address:
Lic. No.:
/VA-
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
_Pereby 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 Liciarrm is e and effect.
License Class -1.17- License N04�
Contractor Z-OngT',za, w Am C
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
U 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.).
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.).
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.
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
ipsu4d rkers' compensation insurance carriepaMoMb ai:
ta�er. 1 --:1 ko-W Policy Numbep�,
I cdrtify that, in the performance of the work for which this permit is issugd, 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.
Applicant��J Vh0rLA,_,J_
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.
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 4/4
/ V pi
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
issue , d 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 underoir 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 inspection purposes.
Date— Signature (Applicant or Agent): ��3
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Application Number . . . . . 05-00-001678
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Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Fee 207.00 Plan Check Fee.. 134.55
Issue Date . . . . Valuation 20000
Expiration Date 10/29/05
Qty Unit Charge Per Extension
BASE FEE 45.00
18-.00 9.0000 -THOU BLDG 2,001-25,000 162.00
-----------------------------------------------------------------------------
Permit . . . . . . MECH POOL
Additional des.c
Permit Fee 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
.Expiration Date 10/29/05
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH-FURNACE >100K 11.00
------------------------------- I ----------------------------------------------
Permit . . . . . . ELEC POOL PERMIT -RES
Additional.desc
Permit Fee . . . . 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation . . . . . 0
Expiration Date.. 10/29/05
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
Expiration Date 10/29/05
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
--------------- 7 -------------------------------- -----------------------------
Special Notes and Comments
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION.. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 311.00 .00, .00 311.00
Plan Check Total 160.55 .00 .00 160.55
Grand Total 4,71.55 .00 .00 471.55
I Bin #
Permit #
X 1 05- IM
roject Address:
A. P. Number
Submittal
plan Stu
Structural Calcs.
Truss CalcL
Energy CMICL
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE:.
Planning Approval
Pub. Wks. Appr
ScboolFees
Avg-
City of La Quinta
Building eZ Safety Division
P-0. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit ApPlication and Tracking Sheet
—or" P,.� b o P,,P-t,4 L 0%%,ner*s Name: ( U/—V I
r2-1 C)
Lic.
Cit% ST. Zip:
Telenhane-
Description:
I 10 -T -A r a
Construction Type: Occupancy:
Project tYP1e (circle one): New," Add'n Alter Repair Demo
Mle�l# N �,�
L lev
Sq. Ft.: 0 Stories: # U
# Uniu-:
A rEstimated value of Prqicct:
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rec'd TRACMG
PERMIT FEES
Plan 0-
C
[Contractor:
Address: X7�
City, ST, Zip:
f*
Telephone:. '11(c,
State Lic. #
Arch., Engr.. Designer
Address:
City. ST. Zip:
Telephone:
State Lic. #:
A
Name of Contact Pe
X LIS�cPhonc
# of Contact Person:
Submittal
plan Stu
Structural Calcs.
Truss CalcL
Energy CMICL
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE:.
Planning Approval
Pub. Wks. Appr
ScboolFees
Avg-
City of La Quinta
Building eZ Safety Division
P-0. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit ApPlication and Tracking Sheet
—or" P,.� b o P,,P-t,4 L 0%%,ner*s Name: ( U/—V I
r2-1 C)
Lic.
Cit% ST. Zip:
Telenhane-
Description:
I 10 -T -A r a
Construction Type: Occupancy:
Project tYP1e (circle one): New," Add'n Alter Repair Demo
Mle�l# N �,�
L lev
Sq. Ft.: 0 Stories: # U
# Uniu-:
A rEstimated value of Prqicct:
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rec'd TRACMG
PERMIT FEES
Plan 0-
Total Permit Fees
Amount
-- su mitted
Item
Reviewed. ready for corrections
Plan Check Deposit
Called Contact Person
.....................
Plan Check Balance
Plans oicked up
........ ...............
Conitruction
Plans resubmitted
hItchanical
2" Review. ready for correctiOns/issue
Electrical
Called Contact person
------------
Plumbing
Plans picked up
SAU.
Plans resubmitted
Grading
Review. ready f r correctionstissue
" 0
......................
Developer Impact Fee
Called Contact person
Date of permit issue
Total Permit Fees
Amount
r
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BUILDING &SAFETY Dr-.
APPROWD,
FOR CONSTRUCTION
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