07-2408 (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:
07-00002408
53748 VIA DONA
772-420-999-31 -298944-
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
35660
Tiht'4 XP Q"
Architect or Engineer:
P'T'
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury [hat I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and 1professionals Code, and my License is in full force and effect.
LicenseCl�27 029 LicenseNo.: 656128
te: trac[or
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 ISec. 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 (5500).:
(_ 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.).
(_ 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
I—) 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.I.
Lender's Name:
Lender's Address: OURS
LQPERMIT
Owner:
BOSWORTH
53748 VIA DONA
LLA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760)777-7153
Date: 8/27/07
D•
It
AUG 28 2007
CITY OF LA QUINTA
FINANCE DEPT.
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.
AI 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 SEABRIGHT Policy Number BB1070510
I 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 come bject to the workers' compensation laws of California,
and agree that, if I sho co a su act to the workers' compensation provisions of Section
3700 of the Labor C al fort ith comply with those provisions.
D plicanv
WARNING: FAILURE TO SECURE RKERS' 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.
certify that I have read this application and state that the abo information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildi co struction, and hereby authorize representatives
of t4coy toenter upon the above-mentioned prop f ins ection purposes.
ture (Applicant or Agent)
Application Number . . . . . 07-00002408
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . 317.00 Plan Check Fee 206.05
Issue Date . . . . Valuation . . . . 35000
Expiration Date . 2/23/08
Qty Unit Charge Per Extension
BASE FEE 252.00
10.00 6.5000 THOU BLDG 25,001-50,000 65.00
--------------- ------------------------------------------------------------
Permit . . . MECH POOL
Additional desc .
Permit Fee . . . . 37.00 Plan Check Fee 9.25
Issue Date . . . . Valuation' 0
Expiration Date 2/23/08
Qty Unit Charge Per Extension
BASE FEE 15.00
2.00 11.0000 EA MECH FURNACE >100K 22.00
-------------------------------------"---------------------------------------
Permit . . . ELEC POOL PERMIT=RES
Additional desc .
Permit Fee . . . . 75.00 Plan Check Fee 18.75
Issue Date . . . . Valuation . . . . 0
Expiration Date 2/23/08
Qty Unit Charge Per Extension
BASE FEE 15.00
.2.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 60.00
----------------------------------------------------------------------------
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 45.00 Plan Check Fee .11.25
Issue Date . . . . Valuation . . 0
Expiration Date . . 2/23/08
Qty Unit Charge Per Extension
BASE FEE 15.00
3.00 6.0000 EA PLB FIXTURE 18.00
2.00 3.0000 EA PLB WATER INST/ALT/REP 6.00
2.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 6.00
-------------------------------------------7--------------------------------
Special Notes and Comments
POOL/SPA IN COURTYARD & POOL ONLY IN
LQPERMIT
Application Number . . . . . 07-00002408
----------------------------------------------------------------------------
Special Notes and Comments
BACKYARD. ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 474.00 .00 .00 474.00
Plan Check Total 245.30 .00 .00 245.30
Utarid Total 1/19.30 .00 .00 715.30
LQPERMIT
Bin #
City of La Quinta
Building 8I Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
a
Project Address: 5.7'-V14 Q0A,)4Owner's
Name: t.s
A. P. Number:
Address:
Legal Description:
Contractor: _
City, ST, Zip:
Telephone:
Address:
147 - 6
Project Description:
City, ST, Zip: Cm ch CI ',A-- rj. —3 6
Telephone:
State Lic. # : 2 City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lie. #:
Project type (circle one): ew Add'n Alter Repair Demo
Name of Contact Person: �r
Sq-FL:
# Stories:
# Units:
Telephone # of Contact Person: Z s^la --J-Estimated
Value of Project--4-g5--0,00
APPLICANT: DO NOT WRITE BELOW THIS LINE
tt
Submittal
Req'd
Rec'd
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
Energy 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
IN 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