06-3510 (RPL)4 P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153,
BUILDING PERMIT
Date: 10/02/06
Application Number: _ 06-00003510 Owner:
Property Address: 80637 VIA PESSARO BEDERIAN
APN: 772-500-059- - 80637 VIA PESSARO
Application description: POOL - RESIDENTIAL ' LA QUINTA; .CA 92253
Property Zoning:. LOW DENSITY RESIDENTIAL
Application valuation: 4500
Cb'ntr-a. dJ:
Applicant: rchitect or Engineer: /� - AINSWORT ONSTR, ROBERT
(Uc,`4240 NM RIVE
t - PAL RT ,92260
Cl OF 6,0j_2 0 0 - 2 8
FINgSt98 81
_ OEAT q ,.
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencingwith I hereby affirm under penalty of perjury one of the following declarations:
,
Section 7000) of Division 3 of the usiness 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
Z ,
Licens lass: 53 Ll No.: 598681 for by Section 3700 of the Labor Code, for the of the work for which this permit is
issued.
ontractor,n /ej l� �Q6 Lr - 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-BUILDER DECLARATION 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 its issuance, also requires the applicant for the person in any ma e o as to bec a 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, i I sho Id seco s bject 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 Lab r Cod I shat fo ith 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 r,
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: U 6 plicant: '
(_ 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 WARNING: FAIL RE TO SECURE IVIKERS' MPE TION 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 PEN TIE ND 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 (5100,000). IN ADDITION TO TH ST 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 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,
(_) 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 issuan5ofmit, or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY permit to cancellation.
L.. _ I hereby affirm under penalty of perjury that there is a-construction lending agency for the performance of theI certify that I have read this application and stateormat' is correct. I agree to comply with all
work for which this permit is issued ISec. 3097, Civ. C.1.city and county ordinances and state laws relatingructi , and her authorize representatives
of thicounter upon t above-mentionedcti rposLender's Name: S atuie (Applicant or Agent
Lender's Address:
LQPERAIIT
LQPERNI IT -
:.Application Number.
06-00003510
Permit . . .
ELEC-MISCELLANEOUS
Additional desc .
- Permit Fee . . .
15.75 Plan Check
Fee
3.94
Issue Date . . .
Valuation
0
Expiration Date
3/31/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00' 7500
PER ELEC DEVICE/FIXTURE 1ST 20
.75 -
Permit . . . . . :
BLDG POOL PERMIT
Additional desc
Permit -Fee
72.00 Plan Check
Fee
46:80
Issue Date . .
Valuation
4500.
Expiration .Date '..
3/31/07
Qty Unit Charge
Per
Extension "
BASE FEE
45.00
3.00 9.0000
THOU BLDG 2,.001-25,000
27.00
Permit . , . :, ;
PLUMBING
4
Additional. desc ...
Permit Fee
21.00 Plan Check
Fee :
5.25
Issue Date : ,
., .: 'Valuation
01
Expiration Date..
3/31/07
Qty Unit Charge
-Per
Extension
BASEFEE
15.00
1..00 6.0000
EA PLB•FIXTURE
6.00
Special Notes and Comment's
FOUNTAIN PER APPROVED
PLAN
Fee summary Charged
Paid Credited
Due
Permit Fee Total
108.75 .00
.00
108.•75
Plan Check Total
55.99 .00
.00
•55.99
Grand Total
164.74 .00
.00
164.74
LQPERNI IT -
Bin # -
x
City of to Quinta
�,...
:Building & Safety Division
r P.O: Box 1504, 78-495 Calle Tampico
Permit .# /1 . ,
1 V
1;
i La Quinta, CA 92253 - (760) 777-7012
3
Building Permit Application and Tracking Sheet
Project Address:"
Owner's Name:,7o(zv) i -
A. P. Number:
Address:U
Legal Descripti n: r
City, ST, Zip:
Contractor: A/SL,J621 CQn/51� (t iqt .-4dr/ '
Telephone:' • `:~,
Address:
Project escripion:. (v- j 17 IV �tiL
City, ST, Zip: VA,
ll ll
Telephone: Q—
l.il4ftit 3
State Lie. # : S"
City Lie,.#:
'>
/'Ols 330I
-
Arch., Engr.,'Designer:
T. °-.
f,
Address:
ti
City, ST, Zip:
`•
`f
Telephone:" +
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
'
State Lie. #:., "
Name of Contact Person: w O l -
Sq. Ft.: :.q ,'" '�
# Stories:
# Units:
Telephone #ofContactPerson: 5��'-`9!� i
Estimated -Value of Project: 141S06
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd -
.: "' 'TRACKING.
PERMITTEES
Plan Sets
Plan Check submitted
Item'
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called .Contact Person
Plan Check Balance e
Energy Calcs.
Plans picked up, °
Construction p
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Revieiv, ready for corrections/issue
Electrical a
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 ApprovalCalled
Cont t Person
A.I.P.P. -
Pub. Wks. Appr
Date of permit issue
School Fees
'
TotalTermit Fees
T - •+. t +� :, 0.r' i' ? . , 4 •, ° �; -IL
,
Id 1-1
m
Ri
0
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