11-1117 (RPL),r ,
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: -11-00001117.
Property Address: C--52945 LATROBE LN
APN: 770 -340 -008 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 32000
. T4'!t 4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
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.
Licen a Class: C53 License No.: 833313
Date: 1b -1 2 - Intractor•
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of p jury 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).:
(_) 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
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, 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.l.
(_ 1 I am exempt under Sec. , BAP.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
Owner:
CHASE JOHN W
52945 LATROBE LANE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/12/11
Contractor: 11D 0
LINDLY'S POOLS OF CALIFORNIA
30755 DESERT PALM DRIVE
THOUSAND PALMS, CA 92276 If•" ^ [0i1 Eu(760)343-0600 E%'
LiC: No.: 833313
CITY Uk j -A OUINTA
r1P44l., -E -:PT.
-----------------------------7-----------------
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 ZURICH AMERICAN Policy Number WC478346400
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 beco a subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shal forthwith comply with those provisions.
tAN
FAILURE TO SECU WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
EMPLAND CIVIL FINES UP TO ONE HUNDRED THOUSAND
1$100,0001. INA ITIONTO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTrON 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 an ,county ordinances and state laws relating to building constructs , and hereby authorize representatives
of s'County to enter upon the above-mentioned property for inspectio purposes.
Date: 10- Q-0 Sign re (Applicant or Agent):
Application Number . . . . 11-00001117
Permit . . .
BLDG POOL PERMIT
Additional.desc .
Permit Fee . . . .
297.50 Plan Check
Fee
193.38
Issue Date . . . .
Valuation
. . .
32000
Expiration Date
4/09/12
Qty Unit Charge
Per
Extension
BASE FEE
252.00
7.00 6.5000
=---------------------------------------------------------------------------
THOU BLDG 25,001-50,000
45.50
Permit . . .
MECH POOL
Additional desc
Permit Fee . . . .
26.00 Plan Check
Fee
6.50
Issue Date . . . .
Valuation
. .
. 0
Expiration Date
4/09/12
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 . .
4/09/12
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
4/09/12
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
Permit . . . . . . WALL/FENCE PERMIT
LQPERMIT
Application Number .. . . . . 11-00001111
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 15.00 Plan Check
Fee
.00
Issue Date Valuation
. . .
. 128
Expiration Date 4/09/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA, 8 L.F. 4' EQUIPMENT ENCLOSURE,
CITY STANDARD. ALARMS/BARRIERS SHALL BE
IN PLACE AT PRE-PLASTER.INSPECTION. 2010
CODES.
-------------------------------------------=--------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
2.00
Fee summary Charged Paid Credited
Due .
Permit Fee Total 416.50 .00
.00
416.50
Plan Check Total 219.38 .00
.00
219.38
Other Fee Total 2.00 .00
.00
2.00
Grand Total 637.88 .00
.00
637.88
LQPERMIT
Bin #: City of La. Quinta
Building 8r Safety Division .
``^ P.O. Box 1504, 78-493 Calle Tampico
Penn1t.# ` La Quinra, CA 92253 - (760) 777-7012
��. Building Pennit Application and Tracking Sheet h
Project Address: '� 4' (� io4 L n . " Owner's Name (�—� S£ i ozm ce
A. P. Number. Address: S"20 '� Wnbe L
Legal Description: City, ST, Zip: J f rTA Cit PaL 5
Contractor: �rr�JYJ`,��j J�� Cul Telephone:
Address: PSV" O(', Project Description:
City, ST, Zip:
Telephone:
State Lic. # : City Lic. #: " Qr/ C
Arch., Engr , Designer
Address: i.. �. X lkiq h -
City., ST, Zip:
Telephone: Construction Type: Occupancy:
State Lie. #: .:. .... .. Project tYPe (circle one): New Add'n Alter Repair Demo
"
...
Name of Contact Person: TQ) e . G1 ^A, �� Z Sq. FL: #Stories: —T# Units:
Telephone # of Contact Person: ` 1 b' 60 l 2. Estimated Value of Project: 7 b') •4b
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACE IING PERMN FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Cheek Deposit
Truss Cala.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted '
Mechanical
Grading plan
Z'' Review, ready for eorrufious/issue -
Electrical
Subcontactor Last
Called Contact Person
Plumbing
Grant Deed
Plans picked up "
S.M.I.
H.OA. Approval
Plans resubmitted
Grading
M HOUSE:-
1rd Review, ready for eorieetions/issue
Developer Impact Fee
Planning Approval
Called Coct Person
A.LP.P.
Pub. Wks. Appr .
Date of permit issue
School Fees
Total Permit Fees
r -