09-1113 (RPL)t
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA', CALIFORNIA 92253
Application Number: i09-00001113 J
Property Address: 54455 WINGED FOOT
APN: 775-110-018- - -
Application description: POOL _ RESIDENTIAL
Property Zoning: 'LOW DENSITY RESIDENTIAL
Application valuation: 20000
Applicant: Architect or Engineer:
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
Owner:
PARRIS MARK S
54-455 WINGED FOOT
LA QUINTA, CA 92253
Contractor: r
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: 10/20/09
LQPERMIT - 1 .
LICENSED CONTRACTOR'S DECLARATION -
WORKER'S COMPENSATION DECLARA ON
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter. (commencing with '
•� - Y P Y I P P � 9 �
I hereby affirm under penalty of perjury one of the following declarations:_
Y P Y P 1 Y 9
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 lass: CB, 10 , 27 , 2 License No.: 656128
for. by Section 3700 of the Labor Code, for the performance of the work for which this -permit is '
/Oate�C/`� ontracto�11 -
/ !!! .
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
OWN ".DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury t I am exempt from the Contractor's State License Law for the
_
Carrier SEABRIGHT Policy Number BB1080510
following reason (Sec. 7031 .5, Busine nd Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, 1 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 becorQaWjbject to the workers' compensation provisions of Section
License Law .(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
of the Lab Co , I forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
�00
-, -
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:
t� plicant-.
I _) 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
WARNING: FII RE TO SECURE RKERS' S. ENSATION COVERAGE IS UNLAWFUL, AND SHALL
" Contractors' State License Law does not apply to an owner of property who builds or improves thereon, -
SUBJECT AN EMPLOYER TO CRI (IAL -PE A`LTIES 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 yearof completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT
" (_) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the'
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for "
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) .1 am exempt under Sec. , B.&P.C. for this reason
- the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Ouinta, its officers, agents and employees for any act or omission related to the work being "
:.performed.under or following issuance of this permit. -
_ `Date: - Owner. -
2: Any permit issued as a result of this application becomes null and void if work is not commenced
-
within 180 days from of issuance of suchpermit, or cessation of work for 180 days will subject
' CONSTRUCTION LENDING AGENCY -
permit to cancellation.
hereby affirm under penalty of perjury that there is a construction lending agency for theperformance of the
I certifythat1 have read this application tate that the above information is correct. I agree to comply with all
• work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and ate laws re to i ding construction, and hereby authorize representatives
' -
of this c my toe [ above -mention, erty for inspection purposes.
Lender's Name:
-
Dat Sign ure (Applican nt):
Lender's Address:
LQPERMIT - 1 .
Application Number . . . . . 09-00001113
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee 207.00 Plan Check
Fee ..
134.55
Issue Date Valuation
20000
Expiration Date 4/18/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
18.00 9.0000 THOU BLDG 2,001-25,000
162.00 -
k2Yt513E . . . MELH PUUL
Additional desc .
Permit Fee . . . 26.00 Plan Check
Fee
6.50
Issue Date Valuation
0
Expiration Date 4/18/10
,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 1
Permit Fee 15.00 Plan Check
Fee
3.75
Issue Date . . . . Valuation
. . . .
0
Expiration Date 4/18/10
Qty Unit Charge Per
Extension
BASE FEE
----------------------------------------------------------------------------
15.00
Permit PLUMBING
Additional desc .
Permit Fee . . . 33.00 Plan Check
Fee
8.25
Issue Date . . . Valuation
. .
0
Expiration Date 4/18/10 '
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
-----------------------
Special Notes and Comments
-------
-------------
-POOL/SPA, APPROVED BBQ & UL APPROVED -
'. RING TO BE INSTALLED. ALARMS/BARRIERS
LQPERA4IT
Bili #
City of La Quints
Building a Safety Division
P.O.. Box 1504, 78-495 Calle Tampico .
La Quinta, C,A 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit#
����
OO
Project Address: �7q-
Owner's Name: � �3r1
A P. Number:/
Address: �o— Fve —
Legal Description: (.�%% /
City, ST, Zip: i �-O, Wh X a
Contractor: 2.<t�- aA
Telephone:
Address: g(CI-100 AVC— S
Project Description:
City, ST, Zip: e0 = CA- 7-7-3
Telephone: 3y� �1 ZZL
State Lic. # : City Lic. #:
Arch., Engr., Designer:
L tl
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: `
Sq. Ft: /
# Stories:
# Units: .
Telephone # of Contact Person:. ." 0—
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Trans Calcs.
Called Contact Person
Plan Cheek 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.L
H O.A. Approval.
Plans resubmitted
Grading
IN HOUSE:
7r° Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A,LP.P,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
5
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