05-3814 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
.05-00.003814•,
78456 VIA PAVION
604-032-009-23 -305211-
POOL - RESIDENTIAL '
LOW DENSITY RESIDENTIAL
12000
T41vl-4 4Q"
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):
(_ I 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 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 imp -roves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
.
11-late:
I I am exempt under Sec. , B.&P..C. for this reason
V Date: 'i(1D' tJ Owner:
CONSTRU91ON 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 Address:
LQPERMIT
Owner:
NICHOLS
78-456 VIA PAVION
LA QUINTA, CA
LA QUINTA, CA 92253
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: ' 8/26/05
AUG 2 6 2005 D
OF LA
WORKER'S COMPENSATION DECLARATION
1 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 =- ------- ------ -- ------ 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 should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: Applicant:
WARNING: - FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL 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'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 anypermit 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 building construction, and hereby authorize representatives
of this unty to enter upon the above-mentioned prop�rt/y/for inspection purposes.
tx
Date:✓/ Signature (Applicant or Agen/.ttj:.
Application Number
05-00003814
Permit
BLDG POOL PERMIT
Additional desc .
Permit Fee
135.00 Plan Check
Fee
87.75
Issue Date
Valuation
. . .
.. 11740
Expiration Date
2/22/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
10.00 .9.0000
THOU_ BLDG 2,001-25,000
90.00
Permit . . .
MECH POOL
Additional desc
-
Permit Fee. . . . .
26.00 Plan.Check
Fee
6�".50
Issue Date
Valuation
. .
. 0.
Expiration Date
2/22/06
Qty Unit Charge
Per '"
Extension
BASE FEE
15.00
1.00 11.0.000
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
2/22/06
C
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..
8.2.5"
Issue Date . . . .
Valuation
0
Expiration Date
2-/22/06
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 .
Permit'
WALL/FENCE PERMIT
LQPERMTT
Application Number . . . . 05-.00003814
Permit . . . WALL/FENCE PERMIT
'
Additional desc
Permit Fee. 15.00 Plan Check
Fee
:•00
Issue.Date . . . . Valuation
. . .
. 260
Expiration Date 2./22/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
- - ----------- - -------------------------------------------
Special
Special Notes and Comments
-------
-
POOL & SPA ONLY. 12 L.F.•5' EQUIPMENT
BLOCK WALL, CITY STANDARD.
ALARMS/BARRIERS SHALL BE'IN PLACE PRIOR
TO PRE -PLASTER INSPECTION.
Fee summary, Charged Paid Credited
- - ------ -- - - -------- -- -- ---- - - - - ------ - - - - ---
Due
--- ------
Permit Fee .Total. 254.00 .00
.00
254.00.
Plan Check'Total 113.75 .00
00
113.75
Grand Total 367!75 .00
.00
367.75
LQPERMIT
,. -
.i
Bin #
C► tO� � � _
Y Qu►nta
Building 8t Safety Division .
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet .
Permit #
2 p
JO
Project Address:
Owner's Name: XS
Address: X l �" , S A
City. ST, Zip: X L`�.Y11/1 Z;-2,53
Telephone: 7Fj
Project Description:'x
A. P. Number:
Legal Description:
Contractor: X
r
Address: 78_ C S6 U l QA Q
City ST. Zip: y, La s3
Telephone: ne:
P —
UD. q
State Lic. #: X°
Citv Lic. #:
Arch., Engr.• Designer:
r
t X ,Sc/6 Ccr�/
Address:
City, ST, Zip:i w if,
Telephone: P S�
ele h one:
Co c
Construction on Type: an \•.
Y O
P cuPc
State'
Ltc. #•
le one):
tYPe (circle rcNew Add' n Alter Repair Demo
Name of Contact Person: S9 Ft.: #Stories: #Units:
Telephone # of Contact Person: - Z Estimated Value of Project: x O
APPLICANT: DO NOT WRITE BELOW THIS LINE
^#
!�
Submittal
Plan Sets
Req'd
Rec'd
TRACKING C,
Plan Check submitted d
PERMIT FEES
Item Amount
IStructural
Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Mechanical
Flood plain plan
Plans resubmitted
Grading-plan
2nd Review, ready for corrections/issue
Electrical
Plumbing
Subcontactor List
Called Contact Person
Grant Deed
Plans picked up
S I.I
Grading
H.O.A. Approval
Plans resubmitted
IN HOUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
opo
�FOF 78-495 CALLE.TAMPICO — LA QUINTA, CALIFORNIA 92253
TELEPHONE (760) 777-7012 FAX (760) 777-7011
e
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible ,
liability if that, person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to'put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of "the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and. Federal Government as an employer' and you are subject
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions. .
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance. ,
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if,
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact-the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contracts "are allowed to perform-their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "OwnerBuilder".building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to -be signed by property owners unless they are performing-their own work
personally.
Information about licensed contractors may be obtained by contacting the ContractorsState License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of,
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA ,
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012 .
FAX: (760) 777-7011TV
4
ON R' IGNATURE TE
A/Jym/ C"/
/a
PROPERTY ADDRESS
PERMIT NUMBER(S) '
fo�
-7 CITY OF LA QUINTA,SUB-CONTRACTOR LIST
JOB ADDRESS' f 2'" �1S(D NAA PIoY i p tJ PERMIT NUMBER i 3x/ OWi'ER� lCli {if -S _ BUILDER— �pl y � LS
This form shall be oosted on the iob with the Building Insaection Ca[d a+ atl fimPe in a conspicuous alace..Only persons appearing on this list or their employees are authorized to work
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 voidance
of building ermit. For each appiicable trade, ali information requested below must be coni leted by applicant. .."On File' is not an acceptable response.
Cit Business Llcense. r
l�
Trade I Classification
Contractor'
.. .� a.q.
;; r."' ;'s i''r. S.t'.ContractoYs Lice�sei
ale
..
;.' ;:.'' :;:'
e. c. .. ..z.
= "' We rs'Com eitsation-lnsurante
.'
.
Company Name
Classification
License Number
Exp. Date'
Carrier Name
Policy Number
(Format Varies(
Exp. pate
lxxlxxlxxl
Llcense Number
(xxxx)
Exp. Date
(xxlxxlxx)
(e.g. A, B, C-81
Ixxxxxxl
(xxlxxlxxll
(e.g. State Fund. Ca[Camp)
EARTHWORK IC -12)
1
Dols
C.
as
6-31-661
CONCRETE (C-8)
C L I -r
Cs
_.. w '
"1 l'i
W
�'
SD
3
-0
FRAMING (C-5)
TRUCT: STEEL {C.51)
>vC
S
'I b
MASONRY (C,291
£ (
Z
Z
;g. -4
_ZV_0 rTk
q " 0
02
000,67
E P
50 2
01
PLUMBING(C-36)(,-72-1950
/ 3
Q2 Sl L
! 5-
Tfl; PLASTER (C-351
G
o
DRYWALL (C-9)
r
HVAC (C-201 ' '' ' '
3 13D
Ob'
LECTRICAL (C=10).: .:
L
azzs ob
r T il5
1 -�(-0
ROOFING'
SHEET METAL IC43)
FLOORING (C:15)'
GLAZING (C;771
INSU LATION: (C-2) . -
SEWAGE
PAINTING IC:33i ..
' r
CERAMIC TILE (C-54)
CABINETS IC -61
FENCING (C-13)
LANING (C-27) '-
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v e
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': • LA QUINTA DEL ORO'
HOMEOWNERSASSOCIATION
APPLICATION FOR ARCHITECTURAL I LANDSCAPE MODIFICATION APPROVAL '
Date;
Owner's Name` CLr Ill t �{ SLS Phone: 2,66 1 �� Q4: `7 71- z3
Property Address: �i0 V'1 f� t �N• 5 R y(s
Modification requested: ) O S, r ° 6k L' Our
To: ARCHIT9CTURAL /LANDSCAPE REVIEW COMMITTEEf
' You are hereby'advised that the above work is proposed and approval is requested.
Attached erre drawings to scale (minimum 1/8" =1') of the
work to be done and types of materiels to be, used are indicated on the drawings. We understand that Building Permits for some modifications
are required by the'Cityof La Quinta, CA:,.and that the costs of the permits:and the responsibility -of obtaining permits and subsequent inspection will
be borne by the applicant. We acknowledge that,all approved changes in the original design will be at our expense; that any damage to or relocation
of existing sprinkler systems, underground utilities, building structure and exterior landscaping to other damage to Association property resulting from
the construction.and/orinstallation of these permitted improvements shall be at aur expense.
We acknovAedae a Security DeaoSlt of $ 2.500.00 to°cover any damage to the common area or cleanup necessary for the completion of the
project NOTE: Large projects only—pool etc. -Thene.will also be° a $ 35.00 ijilication fee. Both the fee & deposit must be submitted prior to
application review. After inspection of the.completed project by theArchitectural Committee, the deposit'will be refunded if all components are
' restored to original or better condition.
"NOTE: construcdon/insta/ladon- of requested and spprovedYmodlflcatlonsymust begin within 45 days of reietpi of -written approval and Bald
modfBcadons must ba completed within 90 days of written appioval.
You are responsible for ensuring your contractor Is properly licensed and ►hared, The Homeowners Assockdon assumes no liability In connection with
ti your project
OWNER SIGNATURE
Send orfax to: '
Personalized Propertyi rdgmt •- tiM Adelina Road -• Cathedral City. Co. 9UX Fax (780) 32S.93ee. ;
Attn: La Quints Del Oro HOA Architedural Commhtae i
The above request has been reviewed by the Architectural Committee: Wapprdved (. ')'derned - O pending '
Comments: T'(/1(' ili3It�S tTY1 ta]/�N1 !` ,
Date reviewed: 5 Deposit Amount `_$2;500.00 Application fee: _$35.00
' ARC Approval By: &U1Board of Directors Approval:
ARC Approval date:
• BOD Approval date:
68=950 Adelina Road
'Cathedral Clty, Ca. 92234
'
(760)32S-950.0 fax (760);,325-9300