05-4372 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO-
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
.Application description
Property Zoning:
.Application valuation:
Applicant:
05-00004372
_43518 PARKWAY ESPLANADE E
609-380-999-75 -293234-
POOL - RESIDENTIAL
LOW DENSITY'RESIDENTIAL
22000
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
HISGEN
43-518 PARKWAY ESPLANADE E
LA QUINTA, CA
LA QUINTA, CA 92253
x -/a,,,)
----------------------------------------------------
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 Busines a Professionals Code,.and_my License is in full force and effect.
License Class: C License No.:
Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjur at I a exempt from the Contractor's State License Law for the
following reason'(Sec. 7031.5, Business a rofessions 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 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, andwhocontracts for the projects with a contractor(s) 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
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:
LQPERMff
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/29/05
Contractor:
/1
TOPMAN BUILDERS
(nj —�
D
WCC: CLARENDON
_-
CSLB: 455120030 842
06/3'f dIG O
20 5
CITY ®F LA QUINTA
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 B C29 C53 Policy Number - - - - - - - - - - - - - --
_ 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 a come subject to the workers' compensation laws of California,
and agree that, i4INT,
ome bj to the workers' compensation provisions of Section' - -
3700 of the Labll fo t comply with those provisions.
e: '�licant: WARNING: FAILURE TO SECUR' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL.
SUBJECT AN EMPLOYER TO CIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDIOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR T, 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 Quints, 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 abo a infor ti is correct. I agree to comply with all
city and county ordinances and state laws relating to building c stru o a d hereby authorize representatives
of ;hisgty to enterLpon the above-mentioned grope y for in tion ur oses.D'a��gnature (Applicant or Agent') '
Aaaitionai
aesc .
Application Number
05-00004372
. . . .
Permit
BLDG POOL PERMIT
6.75
Additional desc .
Valuation . . .
Permit Fee ."
225.00
Plan Check Fee ...
146.25
Issue Date
Qty Unit Charge Per
Valuation
22000
Expiration Date
3/28/06•
BASE
,Qty Unit.Charge-
Per
1.00
Extension
PLS
BASE
FEE
45.00
20.00 9.0000
----------------------------------------------------------------
THOU BLDG
2,001-25,000
180.00
Permit . . .
MECH POOL
PLB
GAS PIPE 1-4.OUTLETS
Additional desc .
Special Notes and Comments
Permit Fee . . .'.
26.00
Plan Check Fee
6.50,
Issue Date . . . .Valuation
. . .
0
Expiration Date
3/28/06
LQPERMIT
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
3/28/06
Aaaitionai
aesc .
Permit Fee
. . . .
27.00
Plan Check Fee
6.75
Issue Date
Valuation . . .
. 0'
Expiration
Date 3/28/06
Qty Unit Charge Per
Extension
BASE
FEE)
-15.00
1.00
6,0000 EA
PLS
FIXTURE
6.00
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 ONLY.
ALARMS/BARRIERS
SHALL
BE IN
LQPERMIT
Application Number . . . . . 05-00004372
----------------------------------------------------------------------
Special Notes and Comments
PLACE PRIOR TO PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED IN
PERMIT.
Fee summary Charged Paid Credited- Due
Permit Fee Total 323.00'• .00 .00 323.00
Plan Check Total- 170.75 .00 .00• 170.75
Grand Total 4.93.75 .00 .00 493.75
-Ati
Bin #
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78 -495 -Calle Tampico
La Quinta, CA 92253 - (760) 777-7012 •
Building Permit Application and Tracking Sheet
Perm* #
Project Address: Sly K4. -
Owner's Name:
A. P. Number:
Address: LA -2
Legal Description:
Contractor: �- M�tJ S
City, ST, Zip: 1._C--4 (�A
hone:
Tele --73,"
p `�� • -75 �
Project Description: "
Address: '1 �Z W�td`�
City, ST, Zip: Cvk1
Telephone: S -735
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephoner s '
State Lic. #: y:
Name of Contact Person:
Construction Type: Cccupancy:
Project type (circle one): New Add'a Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: �(�� .'2,rj• CJ�
Estimated Value of Project: 2,Z
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING "
PERMIT FEES
Z
Plan Sets
Plan Check submitted
g
Item
Amount
IStructural
Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans bicked 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.
`H.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