06-3301 (RPL)-P.O. BOX 1504 VOICE (760) 777-7012
78495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/11/06
Application Number: . C06 00003301 - Owner:
Property Address: ; 80637`VIA PESSARO HARRY BEDERZAN ,
APN: 772-500-059- - - 80637 VIA PESSARO
Application description: POOL RESIDENTIAL LA QUINTA, CA 92253 n
Property Zoning: -LOW DENSITY RESIDENTIAL D Ln!
Application valuation: 30000 r Cp �+ q �+
1 Contractor. JCP 2 U LODU.
Applicant: Architect or Engineer: AINSWORTH POOL CONSTR, B ;
40900 GLENMORE DRIVE CfFVOFLAglAl�iA'
P DESERT
E � • . ALM 2
CA 9 260'
t (760)200-2800
, LF -Lic. No.- 598681 s ,.
-, LICENSED CONTRACTOR'S DECLARATION - r WORKER'S COMPENSATION DECLARATION. •• r
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 infullforce and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Lice ass- 53 Lice e -No.: 598681 for by. Section 3700 of the Labor Code, for the performance of the work for which this permit is
1/ issued.
ate: t/ b . ontractor. S 1 i l% . <I it /C I have and will maintain workers' compensationinsurance, as required by Section 3700 of the Labor '
Code, for the performance of the work for which this permit is issued. Myworkers' compensation
OWNER -BUILDER DECLARATION •' ° C p - , 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 .CALIF. INS Policy Number 460030110102
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 itsissuance, 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 become 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 700 o_ f the Lab r Co e, I shall forthwith comply w'th those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7631.5 by Q C
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.: ate:• _d ;the
��!✓�I �'I �0o l"/
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 foi'sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
- a - 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 -
1 1 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 _ ) 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. I '
Date: Owner:. - 2. Any permit issued as a result of this application becomes null and void if'work is t o 11
mmenced
- within 180 days from date of issuance a
mit, or cessation of work 180 days will subjectCONSTRUCTION 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 applicati and state thinformation is corrt. -I agree to. comply with all
work for which this permit is issued (Sec. 3097, Civ. C.) -city a�ountnances and st laws relating tonstructi , an eby authorize representativesof thister upon t above-mentioned prspec ' u oses.
Lender's Name: n/'D e:US' ature (Applicant or Agentl:
Lender's Address '
• LQPERMIT 1
Application Number 06-00003301
Permit BLDG POOL PERMIT
Additional desc .
Permit. Fee 284.50 Plan Check
Fee
184.93
Issue Date Valuation
30000
Expiration Date 3/10/07
Qty Unit Charge Per
Extension
BASE FEE
252.00
5.00 6.5000 THOU BLDG 251-001-50,000.
32.50
+ Permit MECH POOL
Additional desc
Permit Fee. . . . 26...00 'Plan Check.
Fee
6:50
Issue Date Valuation
0.
Expiration Date 3/10/07
Qty_ Unit Charge`, Per:.„
Extension
` BASE FEE `
15.00
1.00 11.0000 EA MECH FURNACE >1'00K
11.00
Permit . . . ELEC POOL PERMIT -RES'
". Additional desc ,
Permit Fee 45.00 Plan Check
Fee-'.
11.25 :
Issue Date Valuation
_. . .
0
Expiration Date 3/10/07
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 33.00Plan "Check
Fee
8,.25 '
Issue Date. �� Valuation
. .
0
Expiration Date 3/1.0/07
Qty Unit Charge Per
Extension,
BASE FEE
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. ALARMS/BARRIERS SHALL BE IN
Application Number . . . . 06-00003301
--------------------------------------------
Special Notes and Comments
--------------------
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged
Paid
Credited
Due,
Permit Fee Total 388.50
00
.00
388.50
Plan Check Total 210.93
.00
.00
210.'93
Grand Total 599143
.00
00
599.43
J
LQPERDIIT
•
i
I
09
L
M�
J
if
i
I
i
i
I
f
I
I
I
l
I
'
I
/
I
%
I
c.
I
/
I
i�111T,�11�►�.tll►,��!II_!!1►
�111��111 tillPAN
Y
*V1
J
•
i
I
09
>Z)V'913S -NIW .SZ
1 I\
/ I O7
I
CITY Of:�LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE ,a BY
11, 1 It,
:ilrrl A-1
�I r n n
L 1
rtt _� I I 11L :I.1_I
7 flI _1
M.
I+' t, m_
,I
D
Ulu,
L
M�
J
if
i
I
i
i
I
f
I
I
I
l
I
'
I
/
I
%
I
i
I
/
I
/
>Z)V'913S -NIW .SZ
1 I\
/ I O7
I
CITY Of:�LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE ,a BY
11, 1 It,
:ilrrl A-1
�I r n n
L 1
rtt _� I I 11L :I.1_I
7 flI _1
M.
I+' t, m_
,I
D
Ulu,
L
M�
J
aY
a -
II f
--
I
II Ili
II I
II
_
---------JIIL
-------------�
------------ 4�--------
II l
-ir-------------
II .
F::::--__ ___-4�_____________
---------
• II I
L-----------
II
I ---------- -----------i ---------
---I I -- - - -- -----
I II I
I
k=====______j,
II l
—_-- J L—=------
-----
I II
11 l
II
_ I I
----------Ir-------------J
I Iz
9
I
,
------ -----.-'------i
I a
Bin #
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
Permit #
Project Address: U — U3A
Owner's Name:
A. P. Number:
Address: V S U; 43SA2 6
Legal Description:
Contractor: NSA 21 �tJ ( h5v m rQN
City, ST, Zip:
Telephone:
Project Description: QG !` s PA-
Address: —� G(� rjr. Q/linn pp
lJl�,
City,ST Zi
Telephone: �jo - Q
State Lic. #
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: } U� I—
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq'. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: fj1 —
Estimated Value of Project: 3 Q b
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
tRACIQNG
PERMIT FEES
Plan Sets
Plan Check submitted •
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical.
Grading plan
2"" Review, ready for correctionsfissue
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.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total;Permit Fees
m