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