09-1098 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4&t 4 4Qut«tw
Application Number: 09-00001098
Property Address: 48710 VIA LINDA
APN: 658-200-020- - -
Application description: POOL - RESIDENTIAL
Property Zoning: - LOW DENSITY RESIDENTIAL
Application valuation: 35000
Applicant: Architect or Engineer:
411A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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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: C53 t 'cense No.: 348768
ate: Factor:
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 applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ I I, as owner of the property, or my employees .with wages as their sole compensation, will do the work, and .01
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.).
( _-) 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.).
(_ 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/14/09
Owner:
GELDERMANN J JEFFREY
48710 VIA LINDA
LA QUINTA, CA 92253
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LOC"T 15 2009 �! 1
Contractor:
WESTERN POOLS
CITY ®F;
P.O. BOX 5328
��ti--?�EV7
LA QUINTA, CA 92248
".
(760)200-1110
Lic. No.: 348768
--=--------------------------------------------
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 of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1270996-2009
I certify that, in the performance of the work for which this permit is issued, 1 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
3700 of the bor C fo�w�' comply with those provisions.
Aate:
plicant:
WARNING: FAILU E 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.
1 certify that I 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 here.0y authorize representatives
of this county to e(�nrter upon t 'above-mentioned property f � s con o
aH" te: �O ture (Applicant or Agent):
h
Application Number . . . . . 09-00001098
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 317.00 Plan Check Fee 206.05
Issue Date . . . . Valuation . . . . 35000
Expiration Date . . 4/12/10
Qty Unit Charge Per Extension
BASE FEE 252.00
10.00 6.5000 THOU BLDG 25,001-50,000 65.00
----------------------------------------------------------------------------
Permit . . . MECH POOL
i Additional desc . .
Permit Fee . . . . 37.00
Issue Date . . . .
Expiration Date . . 4/12/10
Plan Check Fee . . 9.25
Valuation . . . . 0
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 . . 4/12/10
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 . . . . 42.00 Plan Check Fee 10.50
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/12/10
Qty Unit
Charge
Per
Extension
BASE FEE
15.00
3.00
6.0000
EA
PLB FIXTURE
18.00
1.00
3.0000
EA
PLB WATER INST/ALT/REP
3.00
2.00
3.0000
EA
PLB GAS PIPE 1-4 OUTLETS
6.00
----------------------------------------------------------------------------
Special Notes
and Comments
POOL/SPA, 2ND
SPA & 2
WATER
FEATURES.
LQPERMIT
Application Number . . . . 09700001098
---------------------------------------------------------------7------------
Special Notes and Comments
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. EQUIPMENT
ENCLOSURES NOT INCLUDED. 2007 CODES.
----------------------------------------------------------------------------
Other.Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
2.00
Fee summary Charged Paid
-------------------------------'------
Credited
--------------------
Due
Permit Fee Total 471.00
.00
.00
471.00
Plan Check Total 244.55
.00
.00
244.55
Other Fee Total 2.00
.00
.00
2.00
Grand Total 717.55
.00
.00
717.55
LQPERMIT
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
l
p�
Project Address:
O
Owner's Name: lG f i (' Q
A. P. Number:
Address: 421 (1) V14L
Legal Description:
City, ST, Zip: L� V' C
Contractor: e to rjt� Foo lTelephone:
S
Address: .7 Ar- I p 9ck.
Project Description:
City, ST, Zip: P e vv vAA AvKes CA •
Poo 1 Z - !;f!0,5
Telephone: -00 q777
:`.%;vi:;:tik:"y^~vii::>::vf..%:5:M
State Lie. #: '3 ZJ 7
City Lie.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lie. #:
3 i1,3"•'i.':::f:: a 31Sx. .. £�.;c
. x x
:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: AI(evx6 I k(vt
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 2? S 2
Estimated Value of Project:'
APPLICANT: DO NOT WRITE BELOW THIS LINE
q
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
1
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check B"nee
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2id Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.1.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctlonstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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