07-0573 (RPL)w
•
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760)777-7153,
- BUILDING PERMIT : ..
h - Date: 2/21/07
Application Number: 07-00000573 Owner:
Property Address: 44470 "VIA-CORONADO DAN •& STACY CHILDERS-
APN: 604-211-040-47 -23971 - 44470 VIA CORONADO ,
Application description: POOL'_7 RESIDENTIAL LA QUINTA, CA 92253 ti
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: .18000_png
kCON
pContractor:
Applicant:. Architect or Engineer. NEUBURGER EQPMNT RNT ^^��jj q y I
P.O- BOX 623 D .2 3 LOOT
LA QUINTA, CA 92253
(760) 275-5740 CITYQFLAQUINTA
j Lic. NO:: 746662 PINANCEDEP7
------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that t'am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: - -
Section 7000) of Division 3 of the Business and Professionals Code, and myLicen is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers'' compensation, as provided a_
License Class: C12 C53 i se No.: 746 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�l issued.
ate: tor: I have and w
tra ill 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor.'s State License Law for the Carrier STATE FUND Policy Number 1576693-2006
following reason (Sec. 7031.5; Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work forwhichthis permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State _ and agree that, if 1 should become subject to the workers' compensation provisions of Section - -
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the La e, I shall for1hV7Irtv.QompIy with those o sions. _
r that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by loo �' Q /
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: / icant:
1 _ 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 WARNING: FAILURE TO CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
. • Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND .
and who does.the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
• - (._) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business andProfessionsCode: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person -at whose request and for
• pursuant to the Contractors' State License Law.). • - whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ I I am exempt under Sec. B.&P.C. for this reasonthe 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.
r Date: Owner: - - 2. Any permit issued as a result of this application becomes null and void if work is not commenced '
• _ within 186 days from date of issuance of such permit, or cessation of work for 180 days will subject_
CONSTRUCTION LENDING AGENCY • permit to cancellation.
• I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the - I certify tha I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city an unty ordinances and tate laws relating to building construction, and hereby authorize representatives
oft ' county to enter upon a above-mentioned property for inspectio es.
Lender's Name: - - 'q^rt•p/U:rpo
Date: (/� gnaturelApplicant or Age tI*s•
Lender's Address:
LQPERi1•IIT - - -
Application Number
07-00000573
Permit . . .
BLDG POOL PERMIT
Additional desc
Permit Fee
189.00 Plan Check Fee
122.85
Issue Date
Valuation
18000
Expiration Date
8/20/07
QtyUnit Charge
Per
Extension
BASE FEE
45.00
16.00_ 9.0000
THOU BLDG 2,001-25,000
144.00
Permir
ME(Af POUL
_
Additional desc .
Permit Fee
26.00. Plan'Check Fee
6.50
Issue Date
Valuation . . . .
0
Expiration Date
8/20/07
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
8/20/07
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 ..
8/20/07 '
Qty Unit Charge
Per
BASE FEE"
.Extension
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
. ' LQPERMTT
_
• Application Number 07-00000573
------------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION..
a'
EQUIPMENT ENCLOSURE'NOT INCLUDED
_
_
,• i.F•�
Fee summary Charged
Paid
Credited -
Due
_ _ _
Permit Fee Total •293.00
.00''
.00
293.00
_ Plan Check Total 148.85
.00
.00 ..
•148:85
Grand Total -441.85
.00-
.00
;441-.85 ' E
• LQPERMIT ". .. " - • -.
Bin #
City of La Quinta
Building 9, Safety Division
Permit # P.O. Box 1504, 78-495 Calle �1 Tampico La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:' l -Q r
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: �/"2 Z. -3
Contractor: �c17 e� � u;
Telephone: �? 3 V ^ ff
Address: Z
Project Description:
City, ST, ZiP, / Ji ) /o an
State Lie. # : 7 �6.10 2 L
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person-"/
Telephone #9f Contact Person:
# Submittal Req'd
Reed
Plan Sets.
Structural Calcs.
Truss Cale.
Energy Cale.
Flood plain plan
Grading.pli n
Subcontactor Lift .
Grant Deed
H.O.A. Approval
IN HOUSE:-
Planning Approval
Pub. Wks. Appr
School Fees
Lic. #:
9
Construction Type: Occupancy:
Project type (circle one):ew) Add'n Alter Repair Demo
Sq. Ft.: # Storm: #Units:
Estimated Value of Project:
PPUCANT: DO NOT WFUM BELOW THIS UNE
Plan Check submitted
Reviewed, ready for e
Called Contact Person
Plans picked up
Plans resubmitted
2" Review, ready for
Called Contact- perso
Plans picked up
Plans resubmitted
Review, ready for.c
Called Contact person
.Date of permit issue
TRACIaNG . PERMIT FEES
Item Amount .
orrections Plan Check Deposit
Plan Check Balance
Construction
M�hanical
eorrectionstissue Electrical
° Plumbing
S.M.I.
GmAing
orrections/issue Developer Impact Fee
Total Permit Fees