07-2251 (BLCK)r-:
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t�v 4 eCrv,Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/07/07
Application Number: 07-00002251 c:= Owner:
Property Address: 80546=HERMITAGE PHIL GOLDSTEIN
APN: 762-210-005- - - 80546 HERMITAGE
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL D
Application valuation: 260
Contractor:
AUG[ 14 2001 '
Applicant: Architect or Engineer: PLATINUM POOLS & SPAS
77564 COUNTRY CLUB DRIVE 10
PALM DESERT, CA 92211 01110LFINAWA F!�
(760)772-4274
1 / ^ Lic. No.: 890670
-
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 700P) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Cla$: 125-4 /\_ .( Licksg No.: 890670
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, 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 improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( I 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.
V 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 STATE FUND Policy Number 1863573-2007
_ 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'
workers' compensation provisions of Section
"3700 of the Labor C e hall fort with co 'th those provisions.
plicant:
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 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 cou�y ordinances and state laws relating to ilding onstruction, and her authorize representatives
of this' Gnt to en[er upon th above-mentioned pr pe fo inspect' n purposes Ind Q
ate: S' ata(Applicant or'Ac
Application Number . . 07-00002251
Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit -Fee
15.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
260
Expiration Date
2/03/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
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Special Notes and
Comments
ADDITIONAL 12 L.F.
5' GARDEN WALL, CITY
STANDARD TO ACCOMODATE RELOCATION OF
POOL EQUIPMENT
Fee summary
Charged Paid
Credited
Due
-----------------
Permit Fee Total
--------------------
15.00 •.00
----------
----------
.00
15.00
Plan Check Total
.00
.00
.00
.00
Grand Total
15.00
.00
.00
15.00
LQPERAIIT
Bi" #
City of La Quinta.
Building U 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:' 80 {i E � -- t=
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: L JN
Contractor. L_Kr%tlau r.
Telephone:
Address: 1 S�y�{ .� >J �y.i 10'�
Project Description:
City, ST, Zip: p, �� • �'1.Z 1 \
Tt1�1�\ Z�bIV Al �� I I 1 t ,.
Telephone:"�t_po• a1�1'S •'13�j`Z
f2�,oGK, ly(�LL _ ^`.o 0 5
State tic. # : CityLic: #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type:. Occupancy:
State Lie. #:
Project type (circle one): New Add'n Alter Repair Demo .
Name of Contact Person: �pk�lJ
Sq. Ft :
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: N
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Calcs..
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.
II.O.A. Approval
Pians resubmitted .
Grading
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
LOCATION OF NEW POOL
INCLUDINS NEW EOUIPMENI
MATCH EXIVINS WALLS (
WALKWA
NO
LANDSCA
CHANGE
;II
E)
C�
LG�
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