05-4510 (SOTB)P.O. BOX 1504 c&t!t 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: C05- 004510 Owner:
Property Address: 80300—VIA PESSARO NANCE
APN: _ 772-550-003- - - 80-300 VIA PESSARO
Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3500 O
ID, o tractor:
Applicant: Architect or Engineer- vv TV" C M POOLS INC
• O 1 l• 415 0 BALACLAVA ROAD
IN I CA 760)360-6254 01
Lic. No 838188
LICENSED CONTMAMTOR'S DECLARATION
I hereby affirm under penalty of perjury that am license unde provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Busine nd Profes ovals ode, and my License is in full force and effect.
License Class: C53 Lic nse No.: 838188
_,,.Date: f 6 -w 'U<Comracto,
OW ER-BUILDE DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
r 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 orofferedfor 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.).
1 1 1, 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 contractors) licensed
pursuant to the Contractors' State License Law.). -
(_) 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
ame"—Lender's Address:
LQPERMIT
VOICE (760) 777-7012'�'
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/07/05
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 EXEMPT Policy Number EXEMPT
_ I certify that, in theAsobec
the work which this permit is issued, I shall not employ any.
person in any momes je to the workers' compensation laws of California;'and agree that, e sub) t to he workers' compensation provisions of Section
,/3700 of the Laborth ith c plywiththose provisions.
ate: 1 Q _') Applicant:
WARNING: FAILURE TO SECURE WORKERS' CO PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENAL ES 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'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 actor omission related to the work being
performed under or following issuance of this permit. • 10
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 issuanAsuchper, or cessa ' n f work for 180 days will subject
permit to cancellation.
I certify that1 have read this application and stateorms on is c rrect. I agree to comply with all
city and county ordinances and state laws relatingructi n, and 7ereby authorize representatives
of thiscounty to enterpon the above-mentioned cti n purpo es.
Date .O( i�'�.j/Signature (Applicant or Agen
Application Number .
. . . . 05-00004510
Permit
BUILDING PERMIT
Additional desc .' .
Permit Fee
63.00
Plan Check
Fee
40.95
Issue Date
Valuation
. . .
. 3500
Expiration Date
4/05/06
Qty Unit Charge.
Per
Extension'
BASE
FEE
45.00
2.00 .9.0000.
THOU BLDG
2,001-25,000
18.00
Permit
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee
18.00
Plan Check
Fee
4.50
Issue Date . . .
Valuation
0
Expiration'Date
4/05/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1'.00 3.0000
EA ELEC
APPLIANCES
3.00
Permit
PLUMBING
Additional desc
Permit Fee
.21.00
Plan Check
Fee
5.25
Issue Date
Valuation
0
Expiration Date
4/05/06
-
Qty Unit Charge
.Per
'Extension
BASE
FEE
15.00
1:00 6.0000
EA PLB FIXTURE
6.00
--- -----------------=--------------=----------=----------------------------
Special Notes and Comments
WATER FEATURE WITH SEPARATE
PUMP
&
FILTER
Other Fees . . . .
. ENERGY REVIEW FEE
4.10.
Fee summary Charged
Paid Credited
Due
Permit Fee Total.
102.00
.00
.00
102.00
Plan Check Total-
50.70
00
.00
50.70
Other Fee Total
4.10
.00 -
.00
4.10
Grand Total
156.80
.00
.00
156.80
LQPERMIT
t
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
os-, 4510La
Project Address: .-30 0 ' Q l A-1
Owner's Name: 6U1 ,iC e -
A. P. Number:
Address:
Legal Description:
City, ST, Zip: "
Contractor: C a/►/) �c� e 5 G
Telephone:
O�I ' ,�
Address:/
("'Jr�J �aL�ut/o,,� ��
Project Description:
City, ST, Zip: wl u�e, G C is I ti1'�
Telephon('7(oo)
4-tl mac -
State Lie. # City Lic. #:
Arch:, Engr., Designer:
w. ��-
Address:
City, ST, Zip:
Telephone:v
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): e Add'n Alter Repair Demo
_7
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project: pp
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitte
9 3b
Item
Amount
Structural Calcs.
Reviewed, read corrections
Plan Check Deposit
Truss Cates.
Called Contact P rIN""11111111111
Plan Check Balance
Energy Calcs.
Plans picked up
lD�S'
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"d Review, ready for corrections/issue
Electrical
0
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3rd Review, ready for correcti /issue
NO
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
tt�Y F L-A Q
T�
urN 6AFETY
DEPL
T tal Permit Fees
-W C &Z67C-�I o NS BnJ f'&Z - t7ER1�� Tj V IT U
ON
DAr� 13Y
CITY OF QUINT SUB -
JOB ADDRESS �0-3oo Vto.�EY�I��o CONTRAC OR LI
PERMIT NUMBER OWNER - GLS- BUILDER . ��✓Vl��o �sG. .
This form shall:be os d n h 'ob wit he Buildi Ins c io Card a all im s a c s o s lac Only . • y persons appearing on this list or their employees are authorized to wol
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidanc
of building. permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
-...
Trade C
/ nation .. :.. ::...: .::.::::::::::.::..:..:.: :,:...:;:. ; - .. .....:>.:::
Contractor :::: ......• .... ...:.:.;:.:::..::.;::.:::�.::.:•.::: ; ............. .
Contractor' -tate Contractor s Ucensa Workers Com ensation nsur
p I anc� City B" License
Company Name Classification License Number 1' Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date
CONCRETE (C-8) :>' .'
.. r
FRAMING
TRUCT:'SYEEL (C-51)
MASONRY (6.29)
4
h ( o
.04 1°-"C7C0 (JI� %
F�( a%
(Dl 17
t �
PLUMBING (C-36)
TH; PLASTER =351�alviICcc,
C.
la�o�'C�7
c
��
0(,
311,
Oi
DRYWALL (C-9) :...
=
HVAC. to -20r
ELECTRICAL. (C=10)' :..
SHEET:MET4L (6=43)
ELOO,RING 1C:151:.
GLAZING (C-ilr.
INSULATION'(C4).
SEWAGE DISP-,(C-42)
PAINTING (C=33)
CERAMIC TILE (C-54)
CABINETS (C-61
CES k (JQ f�Ll S
G
l�.
T o
I, r ��
r-lies;-�SeciuNee M
,, ff'' 0 G O
�t�cG !�
FENCING (C713) `
LANDSCAPING (C=27.)
4
POOL (C-53)
�u:n LQ.
n
0 lo' 00 1 -1-L1G
I.,
ofi
•lZ
now :a
G
CONSTRUCTION • REPAIRS SERVICE
(760) 360-6254
• _