09-0974 (RPL)Iff
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00000974
Property Address: 81331 JASMINE CT
APN: 764-280-999-37 -300236-
Application description: POOL - RESIDENTIAL
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 20000
(;??i' 14t 4 rvQ�w
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the�andProfode, and my License is in full force and effect.
License CI 0 to , 3 of 2nse No.: 656128
Date: Contracto .
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury trt.r- exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business ofessions 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).:
(_) 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(sl licensed
pursuant to the Contractors' State License Law.).
1 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:
FORSTENZER RESIDENCE
81-331 JASMINE CT
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/10/09
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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 SEA -BRIGHT Policy Number BB1080510
I certify that, i he performanc of the work for which this permit is issued, I shall not employ any
person in a manner so as to eco subjec the workers' compensation laws of California,.
and agree th if I should beco jec t workers' compensation provisions of Section
J00 of the La Code, I s hw' c ply with those provisions.
Date:% IF Applicant: ,
WARNING: FAILURE TO SECURE WO7NTEREST,
LAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINATIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,0001. IN ADDITION OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, 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 ' ce 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 above i ion ' rrect. I agree to comply with all
city and pty ordinances and state laws relating to buil i , an ereby authorize representatives
of this coto t r upon the above-mentioned pro
Date: Signature (Applicant or Agent):
Application Number .
. . . . 09-00000974
Permit . . .
MECH POOL
Additional desc .
Permit Fee
24.00 Plan Check Fee
6.00
Issue Date . . . .
Valuation
0
Expiration Date . .
3/09/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00. 9.0000
--------------------------
EA MECH FURNACE <=100K
------------------------------------
9:00
--------------
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
207.00 Plan Check Fee
134.55
Issue Date . . . .
Valuation . . .
. 20000
Expiration Date
3/09/10
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
162.00
Permit . ...
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
3/09/10
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 . . . .
27.00 Plan Check Fee
6.75
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
.3/09/10
Qty Uriit"Charge
Per
Extension
BASE -• FEE
1S.00
1.00 6.0000
EA PLB 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
-------
Permit
WALL/FENCE PERMIT
LQPERD4IT
Application Number . . . . . 09-00000974
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 15.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 80
Expiration Date 3/09/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL/ SPA ALARMS BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION. 4FT HT
X 5 LN FT. PER CITY STANDARDS & APPROVED
PLANS. GAS & ELECTRICAL GFI STUB ONLY.
2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 318.00 .00 .00
318.00
Plan Check Total 158.55 .00 .00
158.55
Other Fee Total 1.00 .00 .00
1.00
Grand Total 477.55 .00 .00
477.55
LQPERn4IT
Bin #
Permit #
01—
I—Project
#
Submittal
Project Address:
Rec'd
A. P. Number:
PERMIT FEES
Legal Description:
L
Contractor:
1
Item
Address:
City, ST, Zip:
Telephone:
Plan Check Deposit
/
State Lic. #
Arch., Engr., Designer:
Truss Calcs.
Address:
Called Contact Person
City, ST, Zip:
T 1 h
City of. La Quanta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
(� Owners Name:(��
Af�0 Address: 1// 3� ] aCM 1AA5
t zgm %rl O City: ST, Zip: /�A - rf)v
City Lic. #:
Project Description: s'
4
e ep one. x ��
Construction Type: Occupancy:
State Lic. #: type Project Pro e car P
J (circle one): ew Add'n Alter Repair Demo
Name of Contact Person: c\n '1 r e — Sq. Ft.: 9�j #Stories: #Units:
Telephone # of Contact Person:(?(,o) U7 <Y E
_ sttmated Value of Project: (� .
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
1
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
Zed 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:-
''d 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