06-3519 (RPL)4 P.O. BOX 1504 �VOICE (760) 777-7012
f 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/02/06
Application Number: 06-00003519 Owner:
Property Address: 53600 AVENIDA HERRERA GARCIA SCOTT
APN: 7747124-006-19 -000000- 53600 AVENIDA HERRERA
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253 -
Property Zoning: COVE RESIDENTIAL -------------------- ----- ® --
Application valuation: 12000 c
Contractor: OCT 220 6
Applicant: Architect or Engineer: Owner
CI INANE DIRT
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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 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, 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 ' of build or
improve for the purpose of sale.),
(_) 1, as owner of the property, am exclusively cont r ' g with licensed contractors to cc r t the project (Sec.
7044, Business and Professions Code: The on ractorsL
ense Law doe o pply to an owner of
property who builds or improves thereon, d ho contrhe projects th contractor(s) licensed
pursuant.to the Contractors' State Licens L_
(_ I lame )ecempt under Sec. , B.&P.0 this rea
,-Date: L 11 0 - Owner:
\--_ r / . bNSTRUCTION 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:
LQPERA11T
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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.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of A work for which this permit is issued. My workers' compensation
insurance carrier and policy mber are:
Carrier /Policy Number
I certify that, in the Performa a (the work for which thiZcpensation
ssued, I shall not employ any
person in any manner so to ecome subject to the wpensation laws of California,
and agree that, if I sho ome subje to the rkeprovisions of Section
3700 of the Lab. all fort ocm ith ion
Dat6. 1' Applicant:
iWARNI G: 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 (5100,000). 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 thi permit.
2. Any permit issued as a result of this applic ion becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, ssation of work for 180 days will subject
pe mit to cancellation.
I certify that 1 ave ead this application an th the abov 's -correct. ree to comply with all
city and coun or finances and state laws rela ' buildin ction, hereby thorize representatives
of this 4o to nter upon the above -menti ned p y paction noses. _
Date: . Signature (Applicant or Agent):
Application Number . . . . . 06-00003519
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 135.00 Plan Check
Fee
87.75
Issue Date . . . Valuation
. . .
. 12000
Expiration Date . . 3/31/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
10.00 9.0000 THOU BLDG 2,001-25,000
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90.00
Permit . . . ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 45.00 Plan Check
Fee
11.25
Issue Date . . . . Valuation
. . .
0
Expiration Date 3/31/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING
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POOL
30.00
Permit . . . PLUMBING
Additional desc .
Permit Fee 27.00 Plan Check
Fee
6.75
Issue Date Valuation
. . .
0
Expiration Date.. 3/31/07
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
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Special Notes.and Comments
POOL. ALARMS/BARRIERS SHALL BE IN PLACE
AT PRE -PLASTER INSPECTION. EQUIPMENT
ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited
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Due
Permit Fee Total 207.00 .00
.00
207.00
Plan Check Total 105.75 .00
.00
105.75
Grand Total 312.75 .00
.00
312.75
LQPERMIT
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B'° #
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 #C`
G�
Project Address: bb rte-
Owner's Name:
A. P. Number:
Address: S3 &60 AVC % —
Legal Description:
City, ST, Zip: ��
;CA 6
Contractor: LJ DV_ I �/ ✓
�V
Telephoned
Address:
Project Description: VK ",-JL
City, ST, Zip: ( SV61LIS 7_
Telephone:
`�yy
State Lic. # :
City Lic. #:
Arch., Engr., Designer.
Address: Jill
City, ST, Zip: CA ZZ�of7
Telephone:'��o
State Lic. #:
c
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: ` �'
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: el—
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
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
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
e-z/� CITY OF LA. QUINTA SUB-CONTR TOR LIST
JOB ADDRESS �33w Vgac)ev"i'PERMIT NUMBER OWNER Z GC-6� Gfi'12.Lk BUILDER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. 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 pekr-Ait.. For each applicable trade, all'information requested below must be completed by applicant. "On File" is not an acceptable response.
............
Company Name
Classification
License Number
Exp Date
Carrier er Name
Policy Numberber
Exp. Date
License Number
Exp. P Date
. A B -
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