06-2410 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4t!t 4 1w 4"
Application Number:
06-00002410
Property Address:
81696 IMPALA DR
APN:
764-270-999-78 -300232-
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
5000
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
N IA
--------------------------------------------------
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.
cense CI s: C53 ense No.: 856835
Date: Contractor: Ile
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.).
(_) 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.).
( ) I am exempt under Sec. , BAP.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: I I Q
LQPERMIT
CI
Owner:
MELLEN
81-696 IMPALA DR.
LA QUINTA, CA 92253
Contractor:
VACATION POOLS INC
83900 AVE 45 STE C
INDIO, CA 92201
(760)775-0468
Lic. No.: 856835
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/16/06
]D,, - Q D
JUN 19 2006
CITY OF LA QUINTA
FINANCE DEPT.
-----------------------------------------------
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 STATE FUND Policy Number 1795938-2006
_ 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 Cod)'e�,1I shall fortyl� .th c rnTR9, with those provisions.
DatetJ r Applicant`////` v/ �\ 1 �s
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 count ordinances and state laws relating to building nst ction, and authorize representatives
of unt to enter upon the _ -menti ed p�,PrtVnsp coon oses.
I/Dat(:,L ✓ Signature) licant
Application Number . . . 06-00002410
Permit . . . . .
BUILDING•PERMIT
Additional desc .. .
Permit Fee . . . .
72.00
Plan Check Fee
46.80
Issue Date . . . .
Valuation.
5000
Expiration Date
12/13/06
Qty Unit Charge
Per
Extension .
BASE FEE
45.00
3.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,00.0
27.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . .
15.75
Plan Check Fee
3.94
Issue Date
Valuation . . .
. 0
Expiration Date
12/13/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 .7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE
1ST 20
.75
Permit . . .•
PLUMBING
Additional desc .
Permit Fee . . . .
24.00
Plan Check Fee
6.00
Issue Date . . . .
Valuation
0
Expiration Date
12/13/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 6.0000
EA PLB FIXTURE
6.00
1.00 3.0000
----------------------------------------------------------------------------
EA PLB WATER INST/ALT/REP
3.00
Permit . . .
WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . .
15.00
Plan Check Fee
.00
Issue Date . . .
Valuation
175
Expiration Date..
12/13/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
COURTYARD FOUNTAIN PER
APPROVED PLAN
Fee summary Charged
Paid
Credited.
Due
0
LQPERMIT
a
Application Number . . . ... 06-00002410
---------------------------------------------------------
Permit Fee Total 126.75 .00 .00 126.75
Plan Check Total 56.74 .00 .00 56.74
Grand Total 183.49 .00 .00 183.49
LQPERMIT
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OPTIONAL
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CLEAR
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CITY OF IA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DA'T'E ,,,
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Permit #
City of La Quints
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
t AddresM8//j"?jjTA4
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Owner's Name:umber:
F
oy O
Address: l
Legal Description:
Plan Sets
City, ST, Zip: QtA,� C k.
Contractor. 0
Address: 3 —96q:p
v&-- TW6,
Telephone:
.Project Description: tze T
City, ST, Zip: vtC
yO
elvc(d wa,(! 7 L F,
Telcphon ?!:o)?7S-Q
State Lic. # :
Arch., Engr., Designer:
8
City Lic. #:
Reviewed, ready for corrections
Address:
Plan Check Deposit
City, ST, Zip:
Truss Cates.
Telephone:
Called Contact Person
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stti '
# Units:
Telephone # of Contact Person:
i' 6 3
Estimated Value of Project: �—
I APPLICANT: DO NOT WRITE BELOW THIS UNE I
#
Submittal
Req'd
Rce'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Coles.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Coles.
Plans picked up
Construction
50
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2"' Review, ready for corrections/Issue
Electrical ii„
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
1I.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
31' Rev lew, ready for correctionsrssue
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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