06-3837 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&tv/ 4 4 Q"
Application Number: 06-00003837
Property Address: 81948 VIA LA SERENA
APN: 767-200-011-24 -318741-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4500
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/27/06
Owner: D n -
MICHAEL ROHAN [ice J81948 VIA LA SER
LA QUINTA, CA 9205: OCT 3 0 2006 t
u i
CITY OF LA
FINANCE DEPNT,
Contractor: �
PARZINSKY POOL, INC., RICH
P.O. BOX 897
((
PALM SPRINGS, CA 92263
��
(760) 324-5827
l/►JJ(-V �
Lic. No.: 431055
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury t sed 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 Busine and Profe ionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Licens ass: C8 C53 License No.: 431055
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
at �/ �.� ntractor:el'
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
O ER -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 0000328-2006
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance o rk for which this 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 t become s 'ect 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 I shout me subjec he 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 Labor Cod shal fort w' ply with those provisions.
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 ($5001.:e:
A cant:
(_ 11, 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: FAIL E 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.).
(_ 1 1, 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: y
LQPERMIT
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 beco d void if work is not commenced
within 180 days from date of issuance of such per it,.or cessati work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above in ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building const ti and hereby thor' a representatives
of this cc to enter upon the ove-mentioned property for in ction p os s.
D e:� Si ture (Applicant or Agent):
Application Number . . . . 06-00003837
CR
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 72.00 Plan Check Fee 46.80
Issue Date . . . . Valuation . . . . 4500
Expiration Date 4/25/07
Qty Unit Charge Per Extension
BASE FEE 45.00
3.00 9.0000 THOU BLDG 2,001-25,000 27.00
----------------------------------------------------------------------------
Permit . .
Additional desc .
Permit Fee . . .
Issue Date . . .
Expiration Date .
ELEC-MISCELLANEOUS
17.25
4/25/07
Plan Check Fee . . 4.31
Valuation . . . . 0
Qty Unit Charge
Per
Extension
BASE FEE
15.00
3.00 .7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
2.25
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
18.00 Plan Check Fee
4.50
Issue Date . . . .
Valuation . . . .
0
Expiration Date
4/25/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
-------------------------------7--------------------------------------------
Special Notes and Comments
BBQ PER APPROVED PLAN
----------------------------------------------------------------------------
Other Fees . . .
ENERGY REVIEW FEE
4.68
STRONG MOTION (SMI) - RES
.50
Fee summary Charged
Permit Fee Total 107.25
Plan Check Total 55.61
Other Fee Total 5.18
Grand Total 168.04
LQPERMIT
Paid Credited Due
.00 .00 107.25
.00 .00 55.61
.00 .00 5.18
.00 .00 168.04
Bin f
City of La Quinta
Building u Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
Project Address: li U I SGVLtsA)A
Owner's Name: p f (, 14,l
A. P. Number:
Address: R1 - (Y. U).4 (A. 'S v A
Legal Description:
City, ST, Zip: LG
Contractor: f` P ti S A=.-, L C0 N J i
Telephone:
Address: O g4
Project Description:
.City, ST, Zip: V S
T 6 � -
Telephone: .
State Lie. #:
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Construction Type: O•xupancy:
Project type (circle one): New Add'c Alter Repair
Demo
Name of Contact Person: �'� � �( /,u(�CwL
Sq. FL:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING . PERMIT FEES
Plan Sets
Plan Check submitted Item
Amount
Structural Calcs.
Reviewed,.ready for corrections Plan Check Deposit
Truss Cales.
Called Contact Person Plan Check Balance
Energy Calcs.
Flood plain plan
Plans picked up Constructio a
Plans resubmitted Mechanical
B
Grading,plan
Subcontactor List
Grant Deed
2"' Review, ready for corrections/iissueElectrical
Called Contact Person Plumbing
6hdS
Plans picked up S.M.I.
3 -
ELL
res
vo-CLEgS
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
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