09-0965 (RPL)h.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c& -tit 4 4v Q" -
Applicant: Architect or Engineer:
Iv �K
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
------- - - - - -- -- --------------------------------
L RACTLARATION
I hereby affirm under penalty of perjury that I licensed and ons of Chapter 9 (commencing with
Section 7000) of Division 3 of the B airiess an Pro s Code, and License is in full force and effect.
License ss: C8, 10, 27, o.: 28— —
R DEC
Dat ntractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury th am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Busines 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, 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 prbving 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(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
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:
LAWRENCE
60960 DESERT ROSE DRIVE
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: 9/09/09
------------------
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 Cade, 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 SEABRIGHT Policy Number BB1080510
I certify that, in Xe p formance of the work for which this permit is issued, I shall not employ any
person in any m1��tobecct to the workers' compensation laws of California,
and agree that, ifthe workers' compensation provisions of Section
,3700 of the Laboptp with those provisions.
WARNING: FAILU,K TO SECURE WOERS'COYPENSATION COVERAGE IS UNLAWFUL; AND SHALL
SUBJECT AN EMPLOYER TO CRIMI L PENALTTES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITI 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 at the a ve inform correct. I agree to comply with all
city and county ordinances and state laws relating to 'Iding nstr i y authorize representatives
of t/tt�c ty a pont above-mentioned pr art i o ses.
a'D te: Si ture (Applicant or Agent):
Application Number:09-0000_096.5
Property Address:
60960 DESERT ROSE DR
APN:
764-270-999-189 -300233-
Application description:
. POOL - RESIDENTIAL
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
25000
c& -tit 4 4v Q" -
Applicant: Architect or Engineer:
Iv �K
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
------- - - - - -- -- --------------------------------
L RACTLARATION
I hereby affirm under penalty of perjury that I licensed and ons of Chapter 9 (commencing with
Section 7000) of Division 3 of the B airiess an Pro s Code, and License is in full force and effect.
License ss: C8, 10, 27, o.: 28— —
R DEC
Dat ntractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury th am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Busines 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, 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 prbving 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(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
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:
LAWRENCE
60960 DESERT ROSE DRIVE
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: 9/09/09
------------------
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 Cade, 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 SEABRIGHT Policy Number BB1080510
I certify that, in Xe p formance of the work for which this permit is issued, I shall not employ any
person in any m1��tobecct to the workers' compensation laws of California,
and agree that, ifthe workers' compensation provisions of Section
,3700 of the Laboptp with those provisions.
WARNING: FAILU,K TO SECURE WOERS'COYPENSATION COVERAGE IS UNLAWFUL; AND SHALL
SUBJECT AN EMPLOYER TO CRIMI L PENALTTES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITI 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 at the a ve inform correct. I agree to comply with all
city and county ordinances and state laws relating to 'Iding nstr i y authorize representatives
of t/tt�c ty a pont above-mentioned pr art i o ses.
a'D te: Si ture (Applicant or Agent):
Application Number . . . . . 09-00000965
Permit
BLDG POOL PERMIT
Additional desc . .
Permit Fee
252.00
Plan Check Fee
163.80
Issue Date . . . .
Valuation . . .
. 25000
Expiration Date . .
3/08/10
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
23.00 9.0000
----------------------------------------------------------------------------
THOU BLDG
2,001-25,000
207.00
Permit . . .
MECH POOL
Additional desc . .
Permit Fee . . . .
26.00
Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
3/08/10
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 11.0000
---------------------------7------------------------------------------------
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 . .
3/08/10
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 . . . .
33.00
Plan Check Fee
8.25
Issue Date . . .
Valuation . . .
. 0
Expiration Date
3/08/10
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
Permit . . . . . . WALL/FENCE PERMIT
LQPERMIT
.•Application Number . . . . . 09700000965
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 15.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 325
Expiration Date 3/08/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------
Special Notes and Comments
------------------------------
POOL/SPA, 15 L.F. 416" EQUIPMENT
ENCLOSURE, CITY STANDARD.
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. 2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged. Paid
--------------------
Credited
----------
----------
Due
-----------------
Permit Fee Total 371.00
.00
.00
371.00
Plan Check Total 189.80
.00
.00
189.80
Other Fee Total 1.00
.00
.00
1.00
Grand Total .561.80
.00
.00
561.80
LQPE"11T
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
Permit # A toy
Dq
Project Address: l�f� e a56 W..
Owner's Name: 44 rjl%61e-f
A. P. Number:
Address:
Legal Description:
Contractor:�,� �lj�
City, ST, Zip: G—
Telephone:
Address: 00 A VE --q
Project Description: B�
City, ST, Zip: e0 = L ZZi�
/
/3 5
Telephone:
State Lic. # : City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle on New Add'n Alter Repair Demo
Name of Contact Person: `
Sq. Ft.: ?jF5_
# Stories:
# Units:
Telephone # of Contact Person: -
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Ll q
Item
Amount
Structural Calcs.
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
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I. I
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'" Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
LL
1 Total Permit Fees