05-5504 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00005504
Property Address:
78745 AVENIDA ULTIMO
APN:
770 -092 -006 -2 -000000 -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
18500
c&t�P'4 4 4"
Applicant: Architect or Engineer:
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.
License Class: C12
�-053 License No.: 746662
gate: a'_i,D Contror:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty erjury 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.).
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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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:
PRICE ROBERT H
78-745 AVENIDA ULTIMA
LA QUINTA, CA 92253
Contractor:
NEUBURGER EQUIPMENT
P.O. BOX 623
LA QUINTA, CA -92253
(760)771-9822
Lic. No.: 746662
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/20/05
--------------- 7 --
WORKER'S COMPENSATION DECLARATION
I hereby affirm under. penalty of perjury one of the following declarations:
I have ad 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 1576693-2005
_ 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
.1. 3700 of the Labor ode, I shall forthwith comply with those provisions.
Date V i�bApplica
WARNING: FAILURE TO SE 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 buildi g construction, and hereby authorize representatives
of this co.e try toe.n�lte�r u on the above-mentioned prop or inspection purposes.
Da N a v Signature (Applicant or Age
Cff
S0'1,
LQPERMIT
Application Number ... . . . 05-00005504
Permit
BLDG POOL PERMIT
Additional
desc .
Permit Fee
. . . . 198.00
Plan Check
Fee
128.70
Issue Date
Valuation
18500
Expiration
Date 6/18/06
Qty 'Unit Charge Per
Extension
BASE
FEE
45.00
17.00
----------------------------------
9.0000 THOU BLDG
------------------------------
2,001-25,0.00
153.00
MECH POOL
Additional
desc .
Permit Fee
. . . . 26.00
Plan Check
Fee
6.50
Issue Date
. . . .
Valuation
. . .
. 0
Expiration
Date 6/18/06
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 6/18/06
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 6/18/06
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
ONLY. ALARMS/BARRIERS
SHALL
Application Number 05700005504
------------- -----
Special Notes and Comments
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION..EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid Credited Due
------------------------------------------------------
Permit Fee Fee Total 302.00 .00 ..00 302.00
Plan Check Total 154.70 .00 .00 154.70
Grand Total 456.70 .00 .00 456.70
C -f
4f
cin
LQPERMIT
Bin #
r City of La Quinta
. Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
r Building Permit Application and Tracking Sheet
Permit #
o
Project Address: 7Lf-- 2 y�j OZ1,0 667
Owner's Name:
A. P. Number:
Address:' - c�s yyj v
Legal Description:
Contractor:
City,ST Zi /1
Telephone: a
Address: .(o &;Y. a-
Project Description:
City, ST, Zip: b90� /Q % a
pe_ Q
Telephone:
Ir�
�I
State Lic. # x-53 G 'a-- City Lic. #: "
Arch., Engr., Designer:
r�
Address: •
t
City, ST, Zip:
Telephone: >� ,
State Lic. #:
Name of Contact Person:U>2 !`
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories: "^
# Units:
Telephone # of Contact Person:76 d a— 7S`57 yo
Estimated Value of Project:
'APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Z
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
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.I.
R.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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Steve Fischer a
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Q ty-Pools and Spas it Affordable P
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POOL CAPACITY GALS
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MOTOR HPC► W i✓HP�S
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FILTER
LI`.�,o t SQ
FILTER RATE -
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HEATER ."ihw�ISIZE y00 KBTU
F-� - TURNOVER- fT HRS'
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'_ _:_r . ' . _._. -;._:. �..! I 1 L _r-s"-}--!--=•-� ----w----t-+-•*---' --�---�•~---- CONTRACTOR cannot -assume: responsibility• -fog -,-;.DATE
• I ---�-- �- �- ->-• =--- •-•-------:--�• - ----- t '-�--=- - - � to curbs sid_ ewalk_s driveways,, cement •
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damage -. - - - 'a--'?-T-�•- - --- - -- _ -�- _ _--• - s----' t.
_ - r _ISWn .fences retainin .walls, ,/ /3
_ .-T slabs,_sewe
sprinklers telephone or shrubs, r t "l ' Name:' }�-ri -' -fi--
---! �•-.-4-_,._.'�-J--�-_= - ----1- - - -- --,_f - .i l _ _4_
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When access'is made through a neighbor's prop _i
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- _ .. __ _ i.....,- t._t___.r�i - - - :~ - -r - ner, : have, -that - '-,
T� �-- ' � f _, -` .L. W h ..; .. L t . t _ L I_,_'1
! ! 1 �� + ' - r--�—f s ?- -I i+ . , . _ r? - It -is understood -that you, ..theme ow Address
a.. �•�!-j-
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-; I -r r ---z- -t - t --i-.- •1--. ; �-.- neighbor'spermissionand assumefullresponslbili -.-Y- - -I--` •-a�--, M- �-� ; .•-r-
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