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08-0974 (RPL)P.O. BOX 1504 ^� 78-495 CALLE TAMPICO { LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: `05-0000097Z-- - Owner. Property Address: 053055- VIA—CHIANTE BRAD LUTZ APN: 772-550-009- - - 15021 DAVENPORT LANE Application description: POOL - RESIDENTIAL TARZANA, CA 91356 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 20000 Applicant: Architect or Engineer: LICENSED CONTRA 'S DECLARATION ' I hereby affirm under penalty of perjury that I am licensed d provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the'Business and7Proesna Code, and my License is in full force and effect. License Class: A License No.: 859859 ate ractor. WNER-BUILDER DECLARATION I hereby affirm under penalty of perjury t 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 did not build or improve for the purpose of sale.). 1 _ 1 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 contractorls) licensed pursuant to the Contractors' State License Law.). (_ 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: LQPERMTf �y0 D-•� �� ` L!/J2�/r! . j�` VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/09/08 Contractor: �\ HENRY'S ENGINEERI G P.O: BOX 10290 JUS 0 INDIO, CA 92202 C� la (760) 275-6956 O� / L i c. No.: 859859 •q/y�,�'4 (?U�� 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. 'T I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor T 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 238-000953 I certify that, in the XRKERSCOMPENSATION the rk for which this permit is issued, I shall not employ any person in any mao e subject to the workers' compensation laws of California, and agree that, if ubject to the workers' compensation provisions of Section 3700 of the Laboorthwithcomply with.those provisions.. ate: cant: WARNING: FAILURE TO SECUOMPENSATION 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. f 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 andvoidif work is not commenced within 180 days from date of issuance of such permit, or cessat n of work for 180 days will subject permit to cancellation. // I certify that I have read this application and state that the above inf ation is correct. I agree to comply with all city and county ordinances and state laws relating to building co tn.- , and h reby authorize representatives of this ounty to enter upon t above-mentioned property f I on ses. ateV- S' ature (Applicant or Agent): LQPERMIT Application Number. . . . . 08-00000974 Permit . . . BLDG POOL PERMIT Additional desc . Permit Fee . . . 207.00 Plan Check Fee 134.55 Issue Date - Valuation 20000 Expiration Date 12/06/08 Qty Unit Charge Per Extension BASE FEE 45.00 18.00 9.0000 THOU BLDG 2;001-25,000 162.00 Permit - MECH POOL Additional desc . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation 0 Expiration Date . 12/06/08 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.. 1 Permit Fee45.00 Plan Check Fee 11.25 Issue Date .. . Valuation 0 Expiration Date 12/06/08 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 12/06/08 - 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 --------------------- Special Notes and Comments ---------- POOL/SPA. ALARMS/BARRIERS SHALL BE IN LQPERMIT Application Number . . 08-00000974 ��� ---------------------------------------------------------------------------- Special Notes and Comments PLACE AT PRE=PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee summary Charged Paid Credited Due Permit Fee Total 311.00 .00 .00 311.00 Plan Check Total 160.55 .00 .00 160.55 Grand Total 471.55 .00 .00 .471.55 s LQPERMIT Bin # .. , 'City of la" Quints ; " 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 # r Project Address: S� (� .G Owner's Name: A. P. Number: L illr�-� �iy e�� Address: I SO2 lJ wpl�A nG� Legal Description: Contractor: P Address: L�4 0 4 �.'� Ci _ ty, ST, -Zi p: _T�at?_A-Apt Telephone:' _ Project Description: d c . City, ST, Zip: Telephone:w0 2 � fc . City Lic. #:. . \ ` State Lic. # : _ S' Arch:, Engr., Designer: .e i oe <✓T 1 e Address: City, ST, Zip: P1(A^ Telephone: Construction Type: Occupancy: State Lic. #: t ((� 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: `Z_0 d APPLICANT: DO NOT WRITE BELOW .THIS LINE N Submittal Req'd Recd TRACKING . PERMIT FEES Plan Sets .. Plan Check submitted Item Amount Structural Calc s. Reviewed, ready for corrections Plan Check Deposit Truss Calcs.Called Contact Person Plan Check Balance Energy Calcs. Plans picked up 9 Construction Flood plain plan ". -Plans resubmitted - Mechanical Grading, plan' 2nd Review, ready for corrections/issue Electrical - Subcontactor List Called Contact Person Plumbing Grant Deed' Plans picked up S.M.I. w H.O.A.. Approval Plans resubmitted Grading , IN HOUSE:- • ''d Review, ready for corrections/issue • Developer Impact Fee Planning Approval Called Contact Person A.LP.P. + Pub. Wks. Appr Date of permit issue ,• r School Fees .F s h , • Total Permit Fees Qj P.O. BOX 1504 79A95 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253. Application Number: 08--00000974 —� Property Address: 53055—VIA CHIANTE APN: 772-550-009- - - Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 20000 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: / ,/j/� �%, Architect or Engineer: 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 J111plicant for a permit subjects the applicant to a'civil penalty of not more than five hundred dollars 1$500).: t IV) 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.). (_ 1 .I am exempt under Sec. , B.&P.C. for this reason - ' 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: LQPERn1IT Owner: BRAD LUTZ' 15021 DAVENPORT LANE TARZANA, CA 91356 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/31/09 �,----- A --- u i E ;S iUL ` 2 2339 WORKER'S COMPENSATION DECLARATION 1 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 Policy Number - - 1 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 become subject to the workers' compensation provisions of Section 700 of the Labor Code I shall forthwith comply with those provisions. s pP Date:A lican` � _t:��iJ `- 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 t have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this court y to ter upon the above-mentioned property tiapInspection purposes. /Date: - Signatur`e _IApphcant,or.Agentl: LQPERMIT Application Number . . . . . 08-00000974 Permit . . . MECH POOL Additional desc . Permit Fee . . 26.00 Plan Check Fee 6.50 Issue Date. . . . . 7/01/08 Valuation 0 Expiration Date 12/28/08 Qty Unit Charge Per Extension BASE FEE 15."00 1.00 11.0000 ---------------------------------------------------------------------------- EA MECH FURNACE >100K 11.00 Permit . . BLDG POOL PERMIT Additional desc . Permit Fee . . . . 207.00 Plan Check Fee 134.55 Issue Date . . 7/01/08 Valuation . . . . 20000 Expiration Date 12/28/08 Qty Unit Charge Per Extension BASE FEE 45.00 18.00 9.0000 THOU BLDG 2,001-25,000 162.00 ` Permit . . ELEC POOL PERMIT -RES Additional desc 1 Permit Fee . . . . 45.00• Plan Check Fee 11.25 Issue'Date . . . . 7/01/08 Valuation . . . . 0 Expiration Date 12/28/08 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 7/01/08 Valuation . . . . 0 Expiration Date 12/28/08 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 ---------------------------------------------------------------------------- Special Notes and Comments POOL/SPA. ALARMS/BARRIERS SHALL BE IN s- • j`• Application Number . . . . . 08-00000974 ---------------------------------------------------------------------------- Special Notes and Comments PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED --------------------------------- Other Fees . . . . -------------------------- CHANGE OF CONTRACTOR --- - - - - -- - - --- 4.50 Fee summary Charged Paid Credited Due -- ---------- Permit Fee Total 311.00 ---------- 311.00 ---------- ---------- .00 .00 Plan Check Total 160.55 160.55 .00 .00 Other Fee Total. 4.50 .00 .00 4.50 Grand Total 476.05 471.55 .00 4.50