14-0817 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
14-00000817
Property Address:
78235 DESERT FALL WY
APN:
770-031-029-30 -28019 -
Application description:
POOL - RESIDENTIAL
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
17800
Td�v 4 4 a"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
V�
------------------
UCENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury I am licensed under provisions of Cter 9 (commencing with
Section 7000) of Division 3 of the Busi ass d ProfessiNIsCode my L' e e is in full force and effect.
License Class: C53 No,:' 81 8 5
Date: —�7 "I Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of per)' ry tha am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Busin d 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 1, 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 contractor(s) 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: r
Lender's Address:
LQPERMIT
Owner:
JASON GEOHGAN
78235 DESERT FALLS
LA QUINTA, CA 92253
Contractor:
MC CALLUM POOLS
46576 VIA CELESTE
INDIO, CA 92201
(760)775-5685
Lic. No.: 818835
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/17/14
-----------------------------------------------
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:
Carr' r E •MPT_ Policy Number EXEMPT
ertifythat, 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 L, I shall forthwith comply wit ose ovisions.
Date. Applicant:
WARNING: FAILURE TO SECURE RS' COMPENSATION COVERAGE IS UNLA FUL, 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. 1 agree to comply with all
city and county ordinances and state laws relatin building construction, and hereby authorize representatives
of this countyy%to ent r upon the above-mentioned rop for inspection purposes.
Date: ' '' / Signature (Applicant or Agentl:
Application Number . . . 14-00000817
Permit . . . POOL 2013
Additional desc . .
Permit Fee . . . . 178.75 Plan Check
Fee
.00'
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 12/14/14
Qty Unit Charge Per
Extension
1.00 178.7500 EA MISC POOL/SPA
178.75
----------------------------------------------------------------------------
Special Notes and Comments
POOL (NO HEATER)[AWG IN 1 INCH CONDUIT
ELECTRICAL] THIS PERMIT DOES NOT INCLUDE
ELECTRICAL AT BBQ. EQUIPMENT SHALL BE
INSTALLED IN ACCORDANCE WITH
MANUFACTURER SPECIFICATIONS. ALARMS AND
BARRIERS REQUIRED TO BE INSTALLED AT
PRE -PLASTER INSPECTION. 2013 CALIFORNIA
BUILDING CODE.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . PLAN CHECK, POOL
97.24
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 178.75 -.00
.00
178.75
Plan Check Total .00 .00
.00
.00
Other Fee Total 97.24 .00-
.00
97.24
Grand Total 275.99 .00
.00
275.99.
LQPERNI IT
Lain #
City Of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico.
Quinta, CA 92253 - {760) 777-7012
Building Permit Application and Tracking Sheet
Permit
fLa
l
Project Address: — J Its
Owner's Name:
A. P. Number:
Address: 9 `g e k.;� _FC1
Legal Description:
City, ST, Zip: Lz, 0', rAs, CN c�'Z2S
Contractor:c7�
Telephone: 11
Address: - eProject
Description:��
City, ST, Zip: 2'ZV
Telephone.
State Lic. # :
City Lie. #•.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lic. #:
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11
...................:..................:...............
Construction Type: P� Occupancy:
Project type (circle one) New Add'n Alter Repair Demo
Name of Contact Person: 1 %A
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: ( '_
ci
Estimated Value of Project: 0c) O
APPLICANT: DO NOT WRITE BELOW THIS LINE
t{
Submittal
Rcq'd
Recd
TRACKING
PERMIT FEES,
Plan Sets
Plan Check submitted
4
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Chec alance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for corrections/issue
Electrical r'
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 correctionstissue
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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FOR CONSTRUCTION.
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CITY OF LA QUINTA SUB -CONTRACTOR _ LIST
---JUB-ADDRESS � ? A _.G,..c_P._ERM.(_T NUMBER_ _ _ _ OWNER_L� w.4 .(�eO��jck) ..BUILDECi ' q -,g
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This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division.prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance,
of building permit. for each applicable trade, all intormation requested below must be completed by applicant. "Un tile" is not an acceptable response.
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