11-1041 (RPL)r _ t
P.O- BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number~` '1-1-00001041
Property Address: 81220 LAGUNA-CT
APN: 764-280-004-5 -35996
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
.Application valuation: 16900
Applicant:
c&t!t 4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
pip
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"penaltyof
SED CONTRACTOR'S DECLARATION
I hereby @@ffirt I am licensed under provisions of Chapter 9(commencing with
Section 7b0s and Professionals Code, and my License is in full force and effect.
LicengaCyLicenseNo.: 65899611
1 V OWNER -BUILDER DECLARATION
I hereby a 'rm•u er penalty of perjury tha I am exempt from the Contractor's State License Law for the
following reason 1 ec. 7031 .5, Business an�Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair ny 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 ($500).:
1 _) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does thework himself or herself through his or her own employees, provided that the
improvements are .not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
_ 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. , BAP.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
.Lender's Name:
Lender's Address: p
LQPERMIT
Owner:
TIM & SUE DOTSON
81220 LAGUNA COURT
LA QUINTA, CA 92253
Contractor:
FAMILY POOLS CONSTRUCTION
P O BOX 283
LA QUINTA, CA 92247
(760)564-3655
Lic. No.: 658996
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
tt
Dat1011
C.0$: LA ntmu-r.
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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 o e work for which this permit is issued. My workers' compensation
insurance carrier d pol' number are: '
Carrier STATE FUND Policy Number 1344032-2011
I certify that, in the rformance of the work for which this permit is issued, I shall not employ any
person in an n er so as to become subject to the workers' compensation laws of California,
and agree at, i I hould become subject to the workers' compensation provisions of Section
1 rl 3700 of the L eLVhall forthwith comply with those provisions.
WARN G: AILURE TO SECUREWORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT A EMPLOYER TO CRI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS J$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 ac omission related to the work being
performed under or following issuance of thi ermit. '
2. Any permit issued as a result of this applica o mes null and void if work is not commenced
within 180 days from date of issuance of permit, or cessation of work for 180 days will subject -
permit to cancellation.
I certify th I have read this application and state t t t e bove information is correct. I agree to comply with all
city an cou ty ordinances and state laws relating to con truction, and hereby authorize representatives
of th'�oUpt to enter upon the above-mentioned pr r 1 tion purposes.
Sig ure (Applicant or Agent):
, _ n
Application Number . . . . . 11-00001041
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
180.00 Plan Check Fee
117.00
Issue Date . . . .
Valuation . . .
. 16900
Expiration Date
3/25/12
Qty Unit Charge
Per
Extension
BASE FEE
45.00
15.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
135.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
3/25/12
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
3/25/12
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 . . .
27.00 Plan Check Fee
6.75
Issue Date
Valuation . . . .
0
Expiration Date
3/25/12
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
SPA. ALARMS/BARRIERS
SHALL BE IN PLACE
LQPERMIT
t _ t
LQPERMIT
Application Number
. . . . .
11-00001041
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Special Notes and
Comments
AT PRE -PLASTER INSPECTION.
EQUIPMENT
ENCLOSURE NOT INCLUDED.
2010
CODES.
------------------------------------
Other Fees . . .
. . . . . .
---------------------------------------
BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged
----------
Paid
Credited
--------------------
Due
-----------------
Permit Fee Total
278.00
----------
.00
.00
278.00
Plan Check Total
141.50
.00
.00
141.50
Other Fee Total
1.00
.00
.00
1.00
Grand Total
420.50
.00
.00
420.50
l
Exi5tmg 3' Retaining Wall
2P '
+27"J" spa
+1
Existing Covered Patio
P/L
Exi5ting Raised Planter
6'
32'
GO
5pa Equipment
P/L Mr. * Mrs. Dotson
812 20 Laguna Court
Trilogy -,La Qulnta
— G/E
I
Driveway
Laguna Court
CITY OF LA QUINTA
RUILDIN&SAFETY DEPT.
APPROVED
FOR NSTRUCTION
DAT 9" BY AJ
1�
Ca5ita5
�CY/6i'&.(iti�i
l/
Construction
Pools Spas Fountains.
(760)564-3655 �
Lic. #658996
Bin
IN
City of La Quints
-Building M Safety DlMon
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
iOJO
'
Project Address: .2ZQ
Owner's Name: .
A. P. Number.
Address: 127-0
Legal Description:
City, ST, Zip:
Contractor:
Address:
Telephone:
Project Description:
City, ST, Zip.
Telepho1-0169 -1ne '.
wl
State Lic. # . (p City Lie. &
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
f .
%.
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. FL:
# Stories:
#Units:
Telephone # of Contact Person: -�,3
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACImVGy %/� �rw,
—._.., PERbM FEES
Plan Sets
Pian Check_ submitted
J U �`
Ite i
Amount
Structural Calcs.
Reviewed, ready for corrections
201,Plan
Cheep Deposit
Truss Cates.
Called Contact Person 1[3
1"
Plan Check Balance •
Title 24 Calcs.
Pians picked up .
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correction&4ssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked rip
S.M.I.
H.O.A. Approval
Plans 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