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12-0641 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 1-2 ;000066 id Property Address: 53408 VIA—PALACIO APN: 777-220-022-236 -29894 - Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 35000 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION 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: License No.: Date: Contractor: 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 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 Licen (_) I am exempt under Sec. , B.C..for this eason n /ate: caner: 61 C STRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that a 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: tt T LQPERMIT Owner: DEWEY PAUL C. PO BOX 12793 PALM DESERT, Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/11/12 CA 92255 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 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 Policy Number 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 sho ecome subject tot rkers' compensation provisions of action 3700 of a Labor de, shall fort h co ply ith those provisions. Date pplicant: WARNI G: FAILURE TO SECUORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CR INAL 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'SFEES. 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 bui . constructiM-,_0 authorize representatives ofUfis co ty t enter upon the above-mentioned pro rty f'nspectio ,nature (Applicant or Age Application Number . . . . . 12-00000641 Permit BLDG POOL PERMIT. Additional desc . Permit Fee 317.00 Plan Check Fee 206.05 Issue Date . . . . Valuation . . . . 35000 Expiration Date 12/08/12 Qty. Unit Charge Per Extension BASE FEE 252.00 10.0.0 6.5000 THOU BLDG 25,001-50,000 65.00 ------=--------------------------------------------------------------------- Permit . . . MECH POOL Additional desc . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date Valuation 0 Expiration Date 12/08/12 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 . . Permit Fee 45.00 Plan Check Fee 11.25 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/08/12 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 12/08/12 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, FIREPIT. ALARMS/BARRIERS SHALL LQPERMIT Application Number . . . . . 12-00000641 ---------------------------------------------------------------------------- Special Notes and Comments BE IN PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 2.00 Fee summary ----------------- Charged Paid ---------- CreditedDue Permit Fee Total ---------- 421.00 .00 -------------------- .00 421.00 Plan Check Total 232.05 .00 .00 232.05 Other Fee Total 2.00 .00 .00 2.00 Grand Total 655.05 .00 .00 655.05 LQPERMIT Bln.# CIL}/ Of QLl` to BtAkfing a Safety Division P.O. Box 1504,78-495 Cafle Tamploo LOLdrita, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Perinit # Project Add[ess: OIA. O s Name:. s: 36X jn4j� A P. Number Legal Description: (,� ;Add T, Zip:Contractor. U L ru � one: �� MMAddress: Description:RIO L Rig_ 66,16)( 66O City, ST, Zip: t Telephone: µ ,. ?' r 3 0 Yo 0 State Lia # : City Lic. #; Arch, Engr., Designer. k Div / Address: City., ST. Zip: Telephone: ?M State Lia #: Construction T.ype:. Occupancy: Project type (circle on N Add'n Alter Repair Demo Sq. Ft.: # Stories: #Univ: Name of Contact Person: Telephone # of Contact Person: Estimated Value of Projecir APPLICANT: DO NOT WRITE BELOW THIS UNE 9 Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cale& Reviewed, ready for corrections Plan Chcck Deposit. . Truss Cale*. Called Contact Person Plan Check Balance. Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted.'. Mecharilcal Grading plan 2' Review, ready for corrections/issue Electrical Subeontactor List Called Contact Person Plumbing ". Grant Deed Plans picked up S.M.I. 11.0-A. Approval Pians resubmitted Grading IN ROUSE:- '`' Review; ready for cormctions/Issae Developer Impact Fee Planning Approval. Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees [Total Permit Fees �t U1' CITY OF LA QUINTA'SUB-CONTRACTOR LIST JOB ADDRESS 53-�}p8 UL (�{ GLQgG6 PERMIT NUMBER /a a,1 OWNER BUILDER OT_ This form shall be posted on the lob with the Building Inspection Card at all 'Imeg in a consplouggs place. Onlyersons a on this job. Any changes to this list must be a p appearing on this list or their employees are authorized to work approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/qr the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acce tabl /Classification GontracWr ; $tate;Cun4aotok`s Liceese ,; _771Trade. 1 ers Co p e response ' . ensapon I Ssura►►oe ;:. Company Name Classification (e.g. A, B, C-8) EARTHWORK W-112) rC CONCRETE (P78) (J FRAMING 4C-5) n �+ STRIfCT. STEEL (C-5:11..1 G !i• COI C�� AIC 0ri� C2 \� PLUMBIASO NG PLlfMBW6iC36) - t� � Y�I�C.V'Ii�kYtDiGP!(, LATH, R (C-95) R4 j( C'2 C-5 a-35 DRYWALL (C-9► �� r rL -i c cis .-20 CSU � ELECTRIcaL(c_11o)1113 SHEET METAL ("3) FLOORING:tC-11s) ' C — GLAZING 10-1171 lNsuLATlonr SEWAGE Dim,. IC42j. . aiv iw-aS as LirensR. License Number (xxxxxx) a I (J 70 i6g I g 1 V -L I x/821 �l Exp. Date (xx/xx/xx) l �nn �P 2i2g 3i 31l;Uf✓ 3/31 13��_ 13) 16YVAPIC l I Carrier Name (e.g. State Fund, CalComp) (�„ i W ggow t�����JU��pI,a /LD AIL lk �/K11P % - at'U, l'U $ T-yp< Co 7"Io/P. 11oVJac?6a©063�g1c�t hJ�. ,cw t A-( finch rr le Ulu,Y PolicyNumber (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) f�,�epoc�I ��70 ! 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' 1010.79 INV I 1012.9 FG 1013.56 FS La P001 M SHWR , -GARAGE 1012.8 TG 10129 FG _ o 1010.85 /NV z 10is4•FG• \\ ��etit r%'rtf ,a .`tf�..l 1012.7 TG uM 1011.14 AMV - • 4014.89 .Y1V. ' 'I I••� . t ✓'ttliz"! + 701 yt� r���. € 1 ! - • - ' 'lMM-i" MEW 10 12. ti ,F t`1 pp1� .•, ^�'Z a`r,+Fic! ,,.tZ .. i 1013. 6 F 012 7 EG 2Z: ° 13, 1013.35 FS 701-jpB. -St _ r• ?10128tTG; e• .1010.6 INV 1010.66 INV .a; _. •' I T 2 3 6 �q i LU! l iFA11ARE t 1014. lW , , o 3 : \ r ; PROPOSED RESIDENCE 1013.56 FS INT -A -4. A' p. : 1013.56.fS tt s LA. 1013.60 FF C) FIA Q INT- - 1 j 1013.4 FG ; DE.P.t,1:, POOL BUILD (10i29 o, 1013.39 COPTNGPRO D TRUETIQ�FO 'GO. f , L. 1012.6 TG r;4-- DATE f�f ��'�y.' ✓•' ('1Al2.6 TOP)'t '. 1010.60 INV T7►-�CC FIREPLACE 4 Q=6'1% ': :• I �' R=500 1017.9�fG. ,h t i3^ F L=54.18; �. u•.. t 9® 10 12. 9 FG �fi 1012.8 TG ao12j TG' I 1010.80 wv o:1 10.71.1 (1012.7 TOP) 1-57SPA . � 1014.89 1: 58 0* COPING I� o 1 13.4 FG 4 ,_' t ` � ` .. - • ; 4 '- ' 101,3:34 .F6 , I • `10 .1 ¢13.39 •F I � � � I 1013 127 £G 10129 FG 10.10,52, , ) T ` Y u t, 1 _ '3Tr `` z e lx: 8 FS:•.,Tni' 1009.5. to 6 AV iS - X0128 10126 TG O O �.�� �ft " - _ _ •;25'` O1 .06 t n 101 * 2041Z : 10.52 INV I �5OW 16443, :,'.,�2' :}01.35 7 rY' 1012.5. TG