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11-0312 (RPL)P.O. BOX -1504 78-495 CALLE'TAMPICO LA QUINTA, CALIFORNIA.92253 Application Number: .1-00000312 Property Address: .532997,VIA-PALACIO APN: 772-560-039- - Application description: POOL RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 19500 Applicant: TAI( � ..t44Q BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: • Owner: PRIEM'FAMILY TRUST 12012 KNOTT ST #A2 GARDEN GROVE, CA 92841 ipnn Contractor: AZURE POOLS AND SP VOICE (760) 777-7012 FAX (760) 777-7011 ~ INSPECTIONS (760) 777-7153 Date: 3/-30/11 APR 05 20111 P.O. BOX 10641 'PALM- DESERT, CP, 92 55 CITY OF LAQUINTA (760) 322-7665 FINANCE DEPT !"[ Lic. •No.: 802919. 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 Li n,, ss: C53 License No.: 802919 for by Section 3700 of the Labor Code,'for the performance of the work for which this permit is // issued. –iattee? I �r^,,'f�ra/ctor. -. - - .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-BUILDERDE RATION - - 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 DELOS INS. CO Policy Number 04DKRM1202794 following .reason (Sec. 7031.5, Business and 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, 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 be co a subject 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 3700 of the Labor Code,. I s II orthwith 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. any applicant for, a permit subjects. the applicant to a civil penalty of not more than five hundred dollars (5500).: Date: /� pplicant: A—) 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: FAILURE TO SECURE WORKERS' COMPENSATION COVERA E 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 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.). - - - - APPLICANT ACKNOWLEDGEMENT - (_.) I, 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 I 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 Quinta, 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 date of issuance of such permit, or cessation of work for 180 days will subject, CONSTRUCTION LENDING AGENCY " permit to cancellation. I hereby affirm under penalty of perjury that there.is a construction lending agency for the performance of the - I certify that I have read this application and state that the above information is correct. I agree to complywith all work for which this permit is issued (Sec. 3097, Civ. C.). city an county ordinances and state laws relating to building co�y�I ction, and hereby authorize representatives ON of ' cou ty to enter upo a above-mentioned property for '/�spkction purposes. Lender's Name: - .Lender's Address: - Date: J � / gnature (Applicant or Agentl: LQPERMIT Application Number. . . . . 11-00000312 Permit BLDG POOL PERMIT Additional desc . Permit Fee 207.00 Plan Check Fee 134.55 Issue Date Valuation. 19500 Expiration Date.,. 9/26/11 Qty. Unit.Charge Per Extension BASE FEE 45.00 18.00 9.0000 THOU BLDG 2,001-25,000 162.00 Permit MECH POOL Additional desc Permit Fee . . . . 26.00 Plan Check Fee "6.50 Issue Date Valuation .0 Expiration Date 9/26/11. Qty Unit Charge Per Extension . BASE FEE 15.00 1.00 11.0000 EA MECH FURNACE >100K 11.00•. ' Kermit ELEC POOL PERMIT-RES Additional- desc . Permit Fee . . . 45':00 Plan-Check Fee 11.25 Issue Date Valuation 0 ' Expiration:Date ,.,.' 9/26/11 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. ... 39.00 Plan Check Fee 9.75 Issue Date Valuation. _ 0 Expiration Date 9/26/11 ' Qty Unit Charge. Per Extension BASE FEE 15.00 . 3.00' 6:0000 EA PLB FIXTURE 18.00 .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, LAGOON, FIREPIT & 2 FOUNTAINS. LQPERMIT ., .-. Birt # 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 Permitfl Project Address:' � 3 -.;2 1!?y U/,q L Owner's Name: r /Z, vvr� �/2a c=rZ Tim A. P. Number: Address: :5 3 vZ Ur A'964C/b Legal Description: Contractor: C (JOL S a S City, ST, Zip: Telephone: Project Description: Address: io, a / a y/ City, ST, Zip: � at/ Telephone: 2­2 - 5- --OG! a r% 4 /✓l f /Z — 3- 7 State Lie. # 0a / 9 City Lie. #: Nd Jv wAi 77t9-Y N Arch., Engr., Designer Address: '7 9 S 0,46t C 675 % vg0 6) S 7 c , City, ST, Zip: Telephone ? , 5 (P (l, �/i�'7 State Lie. #: Name of Contact Person: i2 L Construction Type: Occupancy: P cy: Project type (circle one): New Add'n Alter Repair Demo . Sq. Ft.: # Stories: T7Units. Telephone # of Contact Person: (/, 2-. s Estimated Value of Project: ld „ APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACEING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Planspicked up Construction Flood plain plan Plans resubmitted Mechanical I.Grading, plan 2"" Review, ready for correctionslissue 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 correctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees