11-0226 (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:
11-00000226
81172 LAGUNA CT
764-280-004-9 -35996 -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
22000
T4'ht 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BONHAM
81172 LAGUNA COURT
LA QUINTA, CA 92253
Contractor:
TESERRA
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/07/11
P.O. BOX 1280
COACHELLA, CA 92236 U MAN ii 101
(760)398-9222
Lic. No.: 656128 CITY OFLAQUINT
A
FINP_Nr'E AEP7:
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lic sed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busin ss and Pr essionals Code, and my License is in full force and effect.
License Class: 8;1,02729-53 LicenseNo.: 656128
Date: // ontractor:
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 ($5001.:
1 _) 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.).
1 _ 1 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.
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 EVEREST NATL IN Policy Number 7600006481111
1 certify that, in the performance of the work for whi this permit is issued, I shall not employ any
person in any manner so as to become subject t e workers' compensation laws of California,
and agree that, if I sho Id become subject to a orkers' compensation provisions of Section
;760 of the Labor Cod'] shall f hwith co with those provisions.
Date: // plicant: s
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 ove informaLionrrect. I a ree to comply with all
city and county ordina ces and state laws relating to buildin constructiore a orize representatives
of this county e rupon the above-mentioned property f inspe ion.
aQ te: - .i /L Si ture (Applicant or Al
I "Ch
u
LQPERMIT
Application Number . . . . . 11-00000226
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
225.00 Plan Check Fee
146.25
Issue Date
Valuation . . .
. 22000
Expiration Date
9/03/11
Qty Unit Charge
Per
Extension
BASE FEE
45.00
20.00 9.0000
-----------------------------------------------------------
THOU BLDG 2,001-25,000
----------------
180.00
Permit . . .
MECH POOL
Additional desc . .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
9/03/11
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
9/03/11
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 . . . .
27.00 Plan Check Fee
6.75
-Issue Date . . . .
Valuation . . .
. 0
Expiration Date
9/03/11
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
Permit .. . . WALL/FENCE PERMIT
Application Number.
11-00000226
Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 15.00 Plan Check Fee
.00
Issue Date . . .
. Valuation . . .
. 240
Expiration Date
9/03/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and
Comments
POOL. 15 L.F.4' EQUIPMENT ENCLOSURE,
CITY STANDARD. GAS
LINE FOR FIREPIT.
2010 CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total
338.00 .00 .00
338.00
Plan Check Total
170.75 .00 .00
170.75
Other Fee Total
1.00 .00 .00
1.00
Grand Total
509.75 .00 .00
509.75
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 #
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Project Address: 9/ LA(vA/i} 0vv2-r—
Owner's Name: 0A/A0 M
A. P. Number:.
Legal Description:
Contractor:
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Address:
UAI v le -f—
City, ST, Zip: %ZZ
Telephone:
Address: 96/00
Project Description:
City, ST, Zip: C 223 G
Telephone :;>:>:::»::>::;•;:;>.:>::>:::;::;;%::::.::;::;:
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State Lic. #: S 6/. Z b?
City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Mo S PA
Telephone: >•:::::>.;:::>::<; . :;:•>:;::<:
)•'?�:i�i;?C.`,:f:L is ili':{i?{�: iii}}i::: w.,
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State Lic. #:`<•><�;:;:,,>:;:•::•:;:;•;;:.:;:::>:::;:;::::::f•<:»:::<>#:::
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Name of Contact Person: �� c— M
Construction Type: Occupancy:
Project type (circle one): New Add,n Alter Repair' Demo
Sq. Ft.: # Stories: #Units:
Telephone # of Contact Person: p S o 3
Estimated Value of Project: 2 2, Od p
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
Title 24 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.
H.O.A. Approval
Plans resubmitted
Grading
rN 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