11-0538 (SOTB)P.'0. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tit!t
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 11-00000538
Property Address: 81454 GOLDEN POPPY WY
APN: 764-280-999-99 -300236-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 4500
Applicant:
co
Architect or Engineer:
01
Owner:
DEL STAGG
81454 GOLDEN POPPY WAY
LA QUINTA, CA 92253
Contractor:
PLATINUM POOLS & SPAS
77564 COUNTRY CLUB DRIVE
PALM DESERT, CA 92211
(760)772-7274
Lic. No.: 890670
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/24/11
#108IL
. � f MAY 2 G 2011 rct
LCITY OF �.A O.UINTA
F!z:f=. oar')EPT.
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LICENSED CONTRACTOR'S DECLARATION
----------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury th am li ensed 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 Busines a es ' nals 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: C53 License No.: 890670
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ri ractor:
issued.
1 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 pe
Jry1hI amexempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 1863573-2011
following reason (Sec. 7031.5, Busid 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 manneI become bject 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 shme su a 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 Labor CI fort comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by2�.d
h I' ' 'I I f h f' h d d d II 1$5001 '
^ 1 �/ °n'^•' '
any applicant for a permit subjects t e app scant to a c v pena ty o not more t an we un re o ars
(_) 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.).
1 _ 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. i , 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
WARNING: FAILISRE TO SE�{URE WOR RS'
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER 11,`•]'� CRIMINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. INA DIITION T THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABO CODE, NTEREST, 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 ab a yoon i correct. I agree to comply with all
city and county ordinances and state laws relating to building ona hereby authorize representatives
of this county to enter upon the above-mentioned property fo insoses.
'' SSig ure (Applicant or
r r
Application Number . . . . . 11-00000538
Permit BUILDING PERMIT
Additional desc . I.
Permit Fee . . . . 72.00 Plan Check Fee
46.80
Issue Date . . . . Valuation . . .
. 4500
Expiration Date 11/20/11
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
27.00
Permit ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . . 16.50 Plan Check Fee
4.13
Issue Date . . . . Valuation . . .
. 0
Expiration Date 11/20/11
Qty Unit Charge Per
Extension
BASE FEE
.15.00
2.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
1.50
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Special Notes and. Comments
ADD NEW BBQ (2 OUTLETS) & FIREPIT. GAS & .
ELECTRIC LINES EXISTING FROM PREVIOUS
POOL CONSTRUCTION. 2010 CODES.
L
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Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
4.68
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 88.50 .00 .00
88.50
Plan Check Total 50.93 .00 .00
50.93
Other Fee Total 5.68 .00 .00
5.68
Grand Total 145.11 .00 .00
145.11
LQPERMIT
Bin #
City of La Quinta
Building 8r 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: W
Lfaj
Owner's Name: ,04 S
A. P. Number:
Address: Cot L f>
Legal Description:
City, ST, Zip: LoA- Qv 9 Z2j
Contractor:L
v
ig
Telephone:�( ♦♦� s;,.
Address: 2,-(
Project Description:
City, ST, Zip: At C 9 ?-?-11
Telephone: -7(.�, •`x'•:">'s,:>s:s::;:_:.:��:,s:< .;,tt>:
State Lic. # : (p1J City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:s��
State Lic. #:
:::;�f�>�h<_�;:;:):�>�Vk:4:vi::,✓,�.:r»A.:;:::.;:? f<zs
. :.ProJect
Construction Type: Occupancy:
:
tYPa circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: -
Estimated Value of Project: Ll
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
J/06
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' 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