06-2352 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
W �,d �w
06-00002352
53875 AVENIDA DIAZ
774-151-019-7 -000000-
POOL - RESIDENTIAL
COVE RESIDENTIAL
15000
c&ht 4 4 Q"
Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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.
License Class: C12-053 nse No.: 746
Date: 0.6 Contra
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 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. , 8.&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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
-----------------------------------------------
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 1576693-2005
_ 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 hall forth c y with those provisio
Date: /�3 GrApplica r
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 1$100,0001. 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 county ordinances and state laws relating to building construction, and hereby authorize repre tives
of this county to enter upon the above-mentioned pr e r ins pur S.
Date: �� 66 Signature (Applicant o gen
Date: 6/13/06
Owner:
RUBEN & JOSIE NAVARRO
53-875 AVENIDA DIAZ
LA QUINTA, CA 92253
(�
D lj
Contractor:
juN
e
14 NUN
NEUBUAGER EQUIPMENT
RENTAL/ D
P.O. BOX 623
CITY OF
LA QUINTA
LA QUINTA, CA 02253
FINANCE
i)EPT• __J
(760)771-9822
Lic. No.: 746662
-----------------------------------------------
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 1576693-2005
_ 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 hall forth c y with those provisio
Date: /�3 GrApplica r
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 1$100,0001. 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 county ordinances and state laws relating to building construction, and hereby authorize repre tives
of this county to enter upon the above-mentioned pr e r ins pur S.
Date: �� 66 Signature (Applicant o gen
Application Number . . . . . 06-00002352
Permit . . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee
45.00 Plan Check Fee
11.25
Issue Date
Valuation . . .
. 0
Expiration Date
12/10/06
Qty. Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
----------------------------------------------------------------------------
EA ELEC PRIVATE SWIMMING POOL
30.00.
Permit . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
162.00 Plan Check Fee
105.30
Issue Date . . . .
Valuation . . .
. 15000
Expiration Date
12/10/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
13.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
117.00
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
27.00 Plan Check Fee
6.75
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
12/10/06
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
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
--------------------------------------------------------------------=-------
Special Notes and Comments
POOL BARRIERS SHALL BE
IN PLACE AT
PRE -PLASTER INSPECTION.EQUIPMENT
ENCLOSURES NOT INCLUDED.
Fee summary Charged
----------------- ----
Paid Credited
- ----- ---------- ---------- ----------
Due
Permit Fee Total
234.00 .00 ..00
234.00
Plan Check Total
123.30 .00 .00
123.30
Grand Total
357.30 .00 .00
357.30
LQPERMIT
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A RE -INSPECTION F
EE
WILL BE CHARGED IF THEAPPF $3D
ED
PLANS AND JOB CARD ARE NOT ON
THE -SITE FOR A SCHED TON
INSPECTION. UL ED
NO EXCEPTIONS!
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#JETS
Name: Wfag4-� N ihJia
Address: 93 g? S �A Z.
City: C QjI.�
TRACT ' CadC, LOT#
Bi" #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Per//m--it.#
c� • X352
Project Address:
�
Owner's Name:
A. P. Number:
Address: 53
Legal Description:
City; ST, Zip: a01,
Contractor: L4 er- ti �t va3
Telephone:
Address:/
Project Description:
/�1
City, ST, Zip: C 2 -3 _ .
a f
Telephone: aab - 8 / /
J
State Lie. # : 7 G 66 Z
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip: '
Telephone:
Construction Type: a� ccupancy:
State Lie. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: n2 ani
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Perso .
Estimated Value of Project: Q a C-)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING .
PERMIT FEES
24
Plan Sets
Plan Check submitted
//
k9
Item
Amount
Structural Calcs..
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
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.
H.O.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
Q
Total Permit Fees