12-0479 (RPL)` 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: 5/02/12
Application Number: S 12-00000479 i Owner:
Property Address: L_ - 53571 FREMONT WY WEIDNER
APN: 767-710-007-94 -330762- 53571 FREMONT WY D
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW .DENSITY RESIDENTIAL _ p
Application valuation: 33.000 MAY Qv 2012
Contractor: CITY OF lA QUINTA
Applicant: Architect or Engineer: DESERT OUTDOORS INC F(NAN
79405 HIGHWAY 111, PMB 427 CEOEPT.
LA QUINTA, CA 92253
(760)399-9600
LiC. No.: 964474 '
--------------------------7----------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
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 in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C27-053 seNo.: 964474 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ntractor: 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 NORGUARD INS Policy Number DEWC229889
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 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 71 / 3700 oLabor Code, I shall forthw' c mp�e provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by ^I/_ ��(j!►'r
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: A ca /f/✓Z..
(_ 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 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
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.).
(_ 1 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 License Law.).
(_ 1 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: 4
Lender's Address: r,
LQPERMIT
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 160 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, anP raR:� tatives
of this c unty o enter upon the'above-mentioned prope or in pur ...
e
��/
,6t',- v Si tura(Applicant or Agent)
Application Number . . . . . 12-00000479
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
304.00 Plan Check Fee
197.60
Issue Date
Valuation . . .
. 33000
Expiration Date
10/29/12
Qty Unit Charge
Per
Extension
BASE FEE
.252.00
8.00 6.5000
-------------------------------7--------------------------------------------
THOU BLDG 25,001-50,000
52.00
Permit
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date-'.
10/29/12
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
10/29/12
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
10/29/12
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, FOUNTAIN, ALARMS/BARRIERS
LQPERMIT
Application Number . . . . .
12-00000479
----------------------------------------------------------------------------
Special Notes and Comments
SHALL 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
----------
Credited
--------------------
Due .
Permit Fee Total 408.00
.00
00
408.00
Plan Check Total 223.60
.00
.00
223.60
Other Fee Total 2:00
.00
.00
2.00
Grand Total 633.60
.00
.00
633.60
LQPERMIT
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Building 8t Safety Division
Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking
Sh et
Perinit #P.O.
�%►�
Project Address:
Owner's Name:.
Address: a �5
2—
A. P. Number
Legal
Legal Description:
City, ST, Zip: L(
Contractor: Desert Outdoors
Telephone:
_ a'
•:i>..r
Address: 78-065 Main
St. Ste. 205
Project Description:
City, ST, zip: La Quinta,
Ca. 92253
Telephone: 760-399-9600
City Lic. #:
state Lic. # : . e=53 964474
Arch., Engr., Designer: Flying
Buttress
Address: 77725,Enfield
Ln. Ste. 130
City.,ST,zip: Palm Desert,
CA. 92211
Telephone: 760-772-4411a
State Lic. #: 33446
of Contact Person:
Construction Type:. Occupancy:
�u Project circle one): New Add'n Alter R air Demo
1 type ) Repat
Sq. FL: # Stories: # Units:
Telephone # of Contact Person:—
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACICTPtG
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
Title 24 Cake.
Plans picked up
Construction
Flood plain plan
Plans resubmitted. •
Mechanical
Grading plan
V Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review', ready for torreetionslissae
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees