08-0326 (RPL)f
P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
ProDerw Zoning:
Application valuation:
1
08-000_00326
81842 VIA LA SERENA
767-200-011-14 -318742-
POOL - RESIDENTIAL
LQW DENSITY RESIDENTIAL
52500
T4ht 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Businessnd Profess Code, and my License is in full force and effect.
License CI s: 3 License No.: 518742
�Oate: ractor:
T-T-17ir 61
/ 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 _ 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
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 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:
LQPERAIIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
VINCE & SISSY MLANDINICH
81842 VIA LA SERENA
LA QUINTA, CA 922530 t�
Contractor:
AMERICAN POOL NS TI
P.O. BOX 11996 C/Tj. 0 ��oo�
0��q
PALM DESERT, CA 92
(760) 340-2588 qp�F pFpNTq
Lic. No.: 518742
Date: 2/21/08
7/6
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 LINCOLN GENERAL Policy Number CWC00043900
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 become subject to the workers' compensation laws of California,
and agree that, ifAshouldb subject to the workers' compensation provisions of Section
7�3100 ofthe Labrthwply with those provisions.
9ateY pplicant:
WARNING: FAILURE TO SECURMPENSATION 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 nulland 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 I have read this application and state that the above information is correct. I agree to comply with all
city and co nt o dinances and state laws relating to building construction, and hereby authorize representatives
of this co ,tyy/,to nter upon the above-mentioned properly nspecti / oses.
�e� w nature (Applicant or Agent)' ��—
Application Number . . . . . 08-00000326
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
428.00 Plan Check Fee
278.20
Issue Date . . . .
Valuation .
. 52175
Expiration Date
8/19/08
Qty Unit Charge
Per
Extension
BASE FEE
414.50
3.00 4.5000
----------------------------------------------------------------------------
THOU BLDG 50,001-100,000
13.50
Permit . . .
MECH POOL
Additional desc . .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation
0
Expiration Date
8/19/08
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 .
Permit Fee . . . .
45.00 Plan Check Fee
11.25
Issue Date
Valuation . . . .
0
Expiration Date
8/,19/08
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 . .
8/19/08
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
Permit . . . . . . WALL/FENCE PERMIT
LQPERAITT
Application Number . . . . . 08-00000326
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 15.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 325
Expiration Date 8/19/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA, DIVING BOARD, 15 L.F. 5'
EQUIPMENT WALL, CITY STANDARD.
ALARMS/BARRIERS SHALL BE IN PLACE_AT
PRE -PLASTER INSPECTION.
Fee summary Charged Paid
-----------------
Credited
Due
--------------------
Permit Fee Total 547.00
----------
.00
----------
.00
547.00
.Plan Check Total 304.20
.00
.00
304.20
Grand Total 851.20
.00
.00
851.20
LQPERA1IT
Bin 11
City of La Qwnta
HUMIng 8r Safety Division
i .O. Box 1504, 78-495 Ca& Tampico
!a Qtdnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
p
Pro}ect Addsesr.
Y�' (a d a .L i C-
A. P. Number:
Address: 4 U' 4- i/re 11;'
Legal Description:
City, ST, Zip: Lk}- ft V Cli
Contractor: 7 ��, �
�'IC�G
TcicphonG ��
Project Description: ^ /� ✓i /'P.Y�
Address PO . i!—tT' fl I l
City. Sl', Zip: )Pr= YL Z-` ss
15
�(/L • Vit.%ifi2'� ,'j
� '�
State Lia # : City Lie. #;
Arch., Eogr., Designer:
Address:
J
City, ST, Tap:
Telepbonc. Construction Type: Occupancy:
State Lie. #: Project type (circle one)r New Add'n Alta Repair Demo
Name of Contact Person::�'
L ( ! �� -�5 Sq. FL; # Stories: Umiu:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRA IONG
PERMITTEES
Plan Sets
Plan Cheek submitted
item
Araoant
structural Cain.
Reviewed, ready for corrections
Plea Cheek Deponit
Tams Coln.
Cailcd Contact Person
Plan Cliuk Bahner
1iBe 24 Cates.
Plans *kid upConIS
nation
Flood plain plan
Pians reaabmiti.ed
Meebautcal
G--'&" pian
2-! Review, ready for cor rectioasliasae
Eleebical
3nbcAatacbos Iiat
Called Coulad Person
Plumbing
Graut Deed
Plans picked up
SMI.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Revkw, ready for correctionsfnsae
Devcloptr impact Fee
Planting Approval
Called CoolactPerson
Pub. Wks. Appr
Date of pmwt issue
Saba Fees
Total Permit
5-. 3�
57,1 7
[•d 9CV6VL909L apn.ilsuoo food utoiaewy dIZ:ZO 80 OZ gad
Bin #
City of La Quinta
�2Building 8E Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:'
Owner's Name:
A. P. Number:
Address:
Legal Descript• n:
Contractor:
Address: P,� �L
fe.,
City, ST, Zip: &4—
Telephone:
Project Description:
City, ST, Zip:
Telephone.. -;4d
State Lic. # : �j ���`
Arch., Engr., Designer:
City Lic. #:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Name of Contact Person:
Project type (circle one): New Adc'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
---7S
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIONG .
PERMIT FEES .
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Checi Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Constructbn
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"+ Review, ready for correctio 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 =mpact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
0
School Fees
Total Perm -t Fees
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AMERICAN CONCRETE.`INSTITUTE
This is to certify that
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BARRY HALTMAN
D
has demonstrated knowledge and ability by
successfully completing the ACI certification
requirements and is hereby recognized as an
ACI CONCRETE FIELD TESTINGTECHNICIAN
M 1,
GRADE
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vertifs DaW 8!1810-1 -81161121
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: Examiner of Record: Ms Deborah A `- lCl Maea� 'r� Direct6r o --
Priesf, gr g f, Cern catron �-` '
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The: iutl�etztiery o this cern cgtian can: a veri zed at wwiv..flClCerti
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AMERICAN
CONCffl, : TE INSTITUTE
This is to certify .that
has demonstrated knowledge and ability by
successfully completing the AC[erti
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requirements and is hereby recognized as an
ACI-SHOTCRETENOZZLE
MAN, DRY MIX PROCESS, VERTICAL
ONLY
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