07-2539 (RPL)Applicant:
Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT.
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760)777-7153,
Date: 9/17/07
Owner:
P.O. BOX 623
CPNAF�gW
P.O. BOX 1504
LA QUINTA, CA 92253
�If:EGFPt
78-495 CALLE TAMPICO
(760)275-5740
LA QUINTA, CALIFORNIA 92253
Application.Number:
0 7 - 0000253 9
Property Address:
51340 CALLE HUENEME .
APN:
770-164-006- -
Application description:
POOL - RESIDENTIAL,
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
18000
Applicant:
Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT.
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760)777-7153,
Date: 9/17/07
Owner:
P.O. BOX 623
CPNAF�gW
LA QUINTA, CA 92253
�If:EGFPt
BOB ANCKER
(760)275-5740
Lic. No.: 746662
51340 CALLE HUENEME
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
LA QUINTA, CA 92253
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C12 C53 nse No.: 7 2
D
te. ontrac
issued. -
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Contractor:
Code, for the performance of the work for which this permit is issued. My workers' compensation
JUN
122009
NEUBURGER EQPMNT RNTL &
C NS R
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county thavrequires a permit to_
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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) 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: "—t—
LQPERMIT
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 building construction, and e authorize representatives
of/this�°Unt to n[er upon the above-mentioned pro inspection pur oses.
atD e: S' ture (Applicant or ent): _.
P.O. BOX 623
CPNAF�gW
LA QUINTA, CA 92253
�If:EGFPt
(760)275-5740
Lic. No.: 746662
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C12 C53 nse No.: 7 2
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
te. ontrac
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: $�
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 1576693-2006
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county thavrequires a permit to_
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become sub"ect to the workers' csation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the L j2oc.Ge I shall fo wit amply with thos provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
s /{�
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
e:(Y/ U
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
T`t
VPREYTEO
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FSECURE WORKERS' COMPENSATION COVERAGE.IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECTAN TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) 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: "—t—
LQPERMIT
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 building construction, and e authorize representatives
of/this�°Unt to n[er upon the above-mentioned pro inspection pur oses.
atD e: S' ture (Applicant or ent): _.
Application Number .
. . . . 07-00002539
Permit
BLDG POOL PERMIT
Additional desc .
Permit Fee''
189.00 Plan Check
Fee
122.85
Issue Date . . . .
Valuation
18000
Expiration Date
3/15/08
Qty Unit Charge
Per
Extension
BASE FEE
45.00
16.00 . 9.0000
--------------------=-------------------------------------------------------
THOU BLDG 2,001-25,000
144.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check
Fee
6.50
Issue Date
Valuation
. . .
. 0
Expiration Date
3/15/08
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
3/15/08
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 . .
3/15/08
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. ALARMS/BARRIERS
SHALL BE IN
LQPERMIT
Application Number 07-00002539
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged
Paid, Credited
Due
Permit Fee ,Total 293.00
00_� .00.
293.00
Plan Check Total 148.85
.00 .00"
148.85
Grand Total 441.'85
.00 .00
441.85
Y
LQPERMIT
SEP 1 7 200
Dwelling
Bob Ancker
51340 Calle Hueneme
La Quinta, Ca 92253
CITY OF lA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE q, l 8 •m BY KIC
5 ft.
EE)
6X6Spa
1
Bin #
City of La ulnta
Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building*Permit Application and Tracking Sheet
Perrql ff/
0 ���
Project Address:' LIe q C 2 u e.N e M e
Owner's Name: Bpb N r kle !-
A. P. Number:
Address: c5 r's Ho c goct- t' e r e
Legal Description:
Contractor:r
J 6 e r a , S P
Address: . Q 3. o . 3
City, ST, Zip: La- Ou 4 g 2 2 5
Telephone:
Project Description:
is6 L -
City, ST, Zip: Z 2 S 2,
PA
Telephone: S 7 2
City Lic. #:
State Lic. # : Z
Arch., Engr., Designer:
Address:
j
/
City, ST, Zip:.
Telephone:
State Lic. #:
Name of Contact Person: ' 8 S/ zJ
Construction Type:. _ Occupancy:
P cY=
Project type (circle one): New Add'n Alter Repair Demo .
Sq. FL:
#Stories:
#Units: .
Telephone # of Contact Person: / �e
`
Esti' ated Value of Project: 0,9
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG�
PERMrr FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Chcck Balance
Energy Calcs..
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Gradiag. plan .. •
Zed Review, ready for correctionstissueElectrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed.
Plans picked up
S.M.I.
ILO.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