06-3678 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00003678
Property Address:
81948 VIA LA SERENA
APN:
767-200-011-24 -318741-
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
27000
Applicant:
M'
T4ht44Q"
Architect or Engineer:
NIS
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am Ii sed u r ovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busine d Professi Is C e d my License is in full force and effect.
License Class: C8 C53 a No.: 431055
Dater Contractor:
OWNER -BUILDER DECLARATION
hereby affirm under penalty of perjury that I am exempt from the Contrar:tnr's State I ir..ense 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 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
Owner:
MICHAEL ROHAN
81948 VIA LA SERENA
LA QUINTA, CA 92253
Contractor:
PARZINSKY POOL, IN
P.O. BOX 897
PAI•M SPRINGS, CA 9
(760)324-5827
Lic. No.: 431055
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
tRI,T 17 2006
CITY OF LA QUINTA
263 01UAl1 lCG DEPT.
Date: 10/17/06
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.
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 0000328-2006
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 becomes workers' compensation laws of California,
and agree that, if I should become subje t to the worker ompensation provisions of Section
3%700 of the Labor Code, I shall fort ' h mply with thos rovisions.
Date: / Applicant:
WARNING: FAILURE To SECURE WO S' C ATION VERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI AL 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 I have read this application and state that thea 'on is correct. I agree to comply with all
city and county ordinances and state laws relating to building nstruction, her y authorize representatives
of this county to enter upon the above-mentioned property fo i ection purpo
Date: V I / Signature (Applicant or AgenU:
Application Number . . . . . 06-00003678
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 265.00 Plan Check Fee 172.25
Issue Date . . . . Valuation . . . . 27000
Expiration Date 4/15/07
Qty Unit Charge Per Extension
BASE FEE 252.00
2.00 6.5000 THOU BLDG 25,001-50,000 13.00
----------------------------------------------------------------------'------
Permit . . . MECH POOL
Additional desc .
Permit Fee 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/15/07
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 . . 4/15/07
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 . 4/15/07
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
LQPERNIIT
Application Number . . . . . 06-0000.3678
----------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged
----------------- ----------
Permit Fee Total 369.00
Plan Check Total 198.25
Grand Total 567.25
LQPERAfIT
Paid Credited Due
---------- ---------- ----------
.00 .00 369.00
.00 .00 198.25
.00 .00 567.25
Bin #
City of La Quinta
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 #
3 (0-19?
Project Address: - g �� VA 5etizBNA
Owner's Name: t �4 hEL N
A. P. Number:
Address: 9'/ -1 �t� �%I A LA SbM45-A14
Legal Description:
City, ST, Zip:
Contractor: � � f✓ t-+ PNZ2A S #P6-vL Co. -.5r
Address: 46 ri '7
Telephone:
Project Description: V p14 S'�oq /S�
City, ST, Zip: �A lS� 1
Telephone:
State Lic. # : 3-1 v 5S
City Lic. #:
•
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #: t
Name of Contact Person:
Constrgction Type: Occupancy:
Project+ type (circle one): ew Add'r-Alter 'Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:3Z-L49e6 Z.
Estimated Value of Project: a �' 15 O O
APPLICANT:
DO NOT WRITE BELOW THIS LINE
it
Submittal
Req'd
Recd
TRACKING,
PERMIT FEES
2
Plan Sets
Plan Check submitted
�� j2
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
1\4echanical
Grading.piau
2id Review, ready for correctionsrissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
$.M.I.
I-I.O.A. Approval
Pians resubmitted .
Grading
IN HOUSE:
"Review, ready for correctionstissue
Developer Impact Fee. ;
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of -permit issue.
School Fees
LA
J.
Total Perm. t.Fees,.