11-0537 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: {
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
11-00000537
81163 LAGUNA CT
764-280-004-16 -35996
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
31000
I hereby affirm under penalty of perjury that I am
Section 7000) of Division 3 of the Business and I
License Class: C53
ate:5'Z(A' U ntractor:
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perUhe.ys'licensed
exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Busessions Code: Any city or county that requires a permit to
construct, alter, improve, demolish,structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement thpursuant 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.).
(_ 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.).
( ) I am exempt under Sec. , BAP.C. for this reason
c&ht 4 4
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
CONTRACTOR'S DECLARATION
nsed der provisions of Chapter 9 (commencing with
essio s Code, and my License is in full force and effect.
icense'No.: 890670
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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT `
Owner:
SIEGEL
81163 LAGUNA COURT
LA QUINTA, CA 92253
Contractor:
PLATINUM POOLS & SPAS
77564 COUNTRY CLUB DRI
PALM DESERT, -CA 92211
(760)772-7274
Lic. No.: 890670
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (76 0) 777-7153
Date: 5/24/11
r
,1o8MAY 26 26;1
CrTY OF '-A 0:.9NIA
3'N" -'Vit,
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 the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1863573-2011
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 be me bject to the workers' compensation laws of California,
and agree that, if I should b com su to the workers' compensation provisions of Section
/ 3700 of the Labor Code, I hall rth i comply with those provisions.
6ate:7 scant:
WARNING: FAI
E WORK S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO RIMINAL NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). INA DITION TO HE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LAB CODE, I TEREST, 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.
1 certify that I have read this application and state that the above in rma on is correct: I agree to comply with all
city and county ordinances and state laws relating to building cons uctio , and hereby authorize representatives
of thjs county to enter up n the above-mentioned property for ins ectio pu ses.
Date: S 2CaL / Signature (Applicant or Agent
Application Numbet . . . . . 11-00000537
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
291.00 Plan Check
Fee
189.15
Issue Date . . . .
Valuation
31000
Expiration Date
11/20111
Qty Unit Charge
Per
Extension
BASE FEE
252.00
6.00 6.5000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
39.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check
Fee
6.50
Issue'Date . . . .
Valuation
. . . .
0
Expiration Date
11/20/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
------------------------------------------------------------7-7-------------
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
11/20/11
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
11/20/11
`
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 . . . . . 11-00000537
Permit . .
. WALL/FENCE PERMIT
Additional desc .
.
Permit Fee . . .
. 15.00 Plan Check Fee
.00
Issue Date . . .
. Valuation . . .
. 281
Expiration Date
11/20/11
Qty Unit Charge 'Per
Extension
BASE FEE
15.00
=------------
--------------------------------
Special Notes and
7 ------------------------------
Comments
POOL/SPA, 13 L.F.
416" 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
----------
410.00 .00 .00
410.00
Plan Check Total
215.15 .00 .00
215.15
Other Fee Total
2.00 .00 .00
2.00
Grand Total
627.15 .00 .00
627.15
LQPERn11T
Bin # . .
City of La •Quints
Building 8r Safety- Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
BuildingPermit Application and Tracking Sheet
Permit # �3�(
Project Address: g 11 Llk ' v�jz T
Owner's Name: S I
A: P. Number:
Address: g ` ' ]� LA Or
Legal Description:
Contractor:
City, ST, Zip: (,� t CA- _I 2ZT3
, " �, fi M.
Telephone: .. •.:
Project Description:W �L g Y
Address: y ?
City, ST, Zip: meq,. � �- — C�" �I ZZ 1 I
J �%• � `� ' �'��/ � - I�.s:prll_
Telephone:'�(Ot7^7�2`
�"
13 x W lo'1 C . s .
State Lic. # : City Lic.
Arch., Engr., Designer E 5 5 "
Address:
City, ST, Zip:
Telephone: r
State Lic. #: : . 3
Name of Contact Person:
Construction Type: Occupancy:
Project circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person: `% 3
Estimated Value of Project: 3 ppv
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
�+
.J 40
Item
Amount
Structural Calca.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Pian Check Balance
Title 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
1
Date of permit issue
School Fees
Total Permit Fees