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08-1580 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: L _08-0000.1580— .J Property Address: 81443 GOLDEN POPPY WY APN: 764-280-999-117 -300236- Application description: POOL - RESIDENTIAL Property Zoning: MEDIUM HIGH DENSITY RES Application valuation: 15000 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: STAN & DENISE HULTBERG 81443 GOLDEN POPPY WAY LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/17/08 Contractor: Applicant: Architect or Engineer: CROCODILE CONSTRUCTION I OCT 53080 AVENIDA JUAREZ (• /p LA QUINTA, CA 92253 , 0 Cl (760)574-6357 OF Lic. No.: 890415 FaNgN:F FpNTA ------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License lass ABC -8 LicenseNo.: 890415 CO ate: tractor: 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).: 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.). (_ 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 _ 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: Lender's Address: LQPERMIT 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. 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 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. a6 to scant: WARNING: F (LURE TO SECUR 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 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 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 county to enter upon a above-mentioned property for inspection purposes. a8- te: azure (Applicant or Agent): Application Number . . . . . 08-00001580 Permit BLDG POOL PERMIT Additional desc . . Permit Fee . . . . 162.00 Plan Check Fee 105.30 Issue Date . . . . Valuation 15000 Expiration Date 3/16/09 Qty Unit Charge Per Extension BASE FEE 45.00 13.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 117.00 Permit MECH POOL Additional desc . . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/16/09 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 3/16/09 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 --------------7------------------------------------------------------------- EA ELEC PRIVATE SWIMMING POOL 30.00 Permit PLUMBING Additional desc . . Permit Fee . . . . 27.00 Plan Check Fee 6.75 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/16/09 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 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 ONLY. ALARMS/BARRIERS SHALL BE IN LQPERMIT Application Number 08-00001580 ---------------------------------------------------------------------------- Special Notes and Comments PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED. Fee summary Charged ----------------- ---------- Permit Fee Total 260.00 Plan Check Total 129.80 Grand Total 389.80 LQPERMIT Paid Credited ---------- ---------- .00 .00 .00 .00 .00 :00 Due 260.00 129.80 389.80 CITY, OF LA QUINTA JOB ADDRESS] 1--� PERMIT NUMBER This form shall be posted on the job with the Build ng Inspection -Card at all times in a cc on this job. Any -change's to this list must be approved by the Building Division prior to cr of building permit. For each applicable trade, all information requested below must be cc Trade / Classification Contrac t. a ' ontr >: W. -C actisr's. LicetSse. .. .• .:: � :� • .. ke sat �- • ••. •':::::' . �.:. ....3 .rN4r .GoM en (ofi.:1n$uranCe:••:.:•-:' ... :.{<::.:: r:S•Busitle�s Company Name Classification (e.g. A. B, C=8) P License Number (xxxxxx) (e. . State Fund, (Comp) EARTHWORK (C-12 j ...; ' LK- License Number (xxxx) Exp. Date (xx/xx/xx) C.ONCRETf 1C-8) ' c �. L l t - ( � FRAMING'.4C-5) � :' ;` • :. � � l l � it fit STRUeT-..- FEEL -(C -5a) Mi4SONRY'(C•291 L PLUMBING (C-361 ' ' . . 1:ATF(; PLASTER (Cs35) ' (.Lr.��•� {+�l.l-o�/ I �, � DRYWALL (C-9) •.:. ,:- 4t L HVAC. E!. CTRICAL. (C=10)' RQ•• FIN(3•'(4=39)`;,;r;�.F'.::. :SHE . -ETAL (0.43) ECO BIN=:151:.'<`:.?': s GLAzWG, (G INSULATI0N:`(G72) : ..:: . SEWAGE plSp; PAINTING (C-334'-: CERAMIC TILE• (C-54) CABINETS (C-6) FENCING (C-13) } ( �lr. L c,1/'/ t LANDSCAPING (C=27.) '•'°' POOL (C-53) UB -CONTRACTOR .IST • - ' C�� �� colOWNERSMW�64W7� BUILDER . p & us place. Only persons appearing on this list or'their employees are authorized to work mencer�ent of work. Failure to comply.will result in a stoppage of work and/or the voidance pleted by applicant. "On File" is not an acceptabld response. P. ;.•..., ,..:.: .. .• .:: � :� • .. ke sat �- • ••. •':::::' . �.:. ....3 .rN4r .GoM en (ofi.:1n$uranCe:••:.:•-:' ... :.{<::.:: r:S•Busitle�s .:�'•. city License:::>.::: xp. Date x/xx/xx) (e. . State Fund, (Comp) Policy Number (Format Varies) Exp. Date (xx/xxlxx) License Number (xxxx) Exp. Date (xx/xx/xx) ' n (7q.;W7 4-1- l oa 90 7 � I � � l • -4 C7 it fit L Ulf, 4t L 4. i 1 U. 'A ITz. AL A 0 CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATEJ:J-7-09BY—i(jL Imo- * � ���'� 1w & £ • t * o b* 40" wo 1 0 it 0 obw�, 34 00 *4, A6,W IWO Chuck Cooper Environmental Planning + Design 81720 Daniel Drive La Quinta CA 92253 —Atk&- 43 Bin # City of La Quinta Buildi ' ng'& Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building. Permit Application and Tracking Sheet Permit # I.Project Address:8 i_O Llys gpLzw I%% WIAM Owner's Name: 4 Dew 15 Lab A. P. Number: Address: N -LID abw Y Legal Description: Contractor: Cy-Cc0f)x'G Gpjr^-I- Vock -A --'J City, ST, Zip:q L4 QuIOT-A (?JA, ,2z -!c - Telephone: impugn IN Address: u Project Description: City, ST, Zip: —IF j�ep im Ct 22, L, Telep6nefl&o'lsI gel a State Lic. # P) 402AC) City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: i State Lic. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.:_# Stories: # Units: -7 0. Estimated Value of Project: $1 1 10 00 APPLICANT: DO NOT WRITE BELOW THIS LINE 0 Submittal Req'd Rcc.1d TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Energy Cates. Plans Picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"J Review, ready for corrections/issue 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.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees * - -04- -, - -* -�. X