07-1781 (RPL)r,.0. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property. Zoning:
Application valuation:
Applicant:
07-00001781
81765 VIA LA SERENA
767-200-011-18 -318742-
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
15000
Architect or Engineer:
Ok
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 Business and Professionals Code, and my License is in full force and effect.
License Class: C53 C27 license No: 419309
Date: iA Contractor:
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 155001.:
(_ 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.).
(_ 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:
LQPERN11T
Owner:
DEGAN RESIDENCE
81-765 VIA LA SERENA
LA QUINTA, CA 92253
Ind -E
Contractor:
DESERT PARADI
78005 WILDCA DI
PALM DESERT, I
CA
(760)360-74000
Lic. No.: 419309
VOICE (760) 777-701.2
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
INC t i
zo�007 / .
Date: 6/19/07
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 ENDURANCE WORK Policy Number WVS001347901
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, if I should b ome subject to the workers' compensation provisions of Section
3700 of the Labor Co _hall forthwith comply with those provisions.
Dat]7Applica
WARNING: FAILURE TO S RE WORKER ENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYE CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). N 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 the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construc 'on, and hereby authorize representatives
of this county
county to enter upon the above-mentioned proper or insp ion purposes.
Date+ Signature (Applicant or Ag
Application Number 07-00001781
Permit . . .
BLDG POOL PERMIT .
Additional desc .
Permit Fee . . . .
162.00
Plan Check Fee
105.30
Issue Date
Valuation . . .
. 15000
Expiration Date
12/16/07
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
13.00 9.0000
----------------------------------------------------------------------------
THOU BLDC
2,001 25.;000
117.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00
Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
12/16/07
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
12/16/07
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
12/16/07
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
-------------------------------------7--------------------------------------
Special Notes and Comments
POOL, SPA, ALARMS/BARRIERS
SHALL
BE IN
LQPERMIT
Application Number . . . . . 07-00001781
---------------------------------------------------------------=------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
Fee summary Charged
----------------- ----------
Permit Fee Total 266..00
Plan Check Total 131.30
Grand Total 397.30
LQPERMIT
Paid Credited Due
---------- ---------- ---=------
.00 .00 266.00
.00 .00 131.30
.00 .00 397.30
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 #
Project Address:' 6 I — 76 j Jae N
Owner's Name:
A. P. Number:
Address: -,q G_A Nye
Legal Description:
City, ST, Zip: Z q�file %��,%�
Contractor: T
Telephone:
Address: 7 �j�Jt- a 17j
Project Description:
City, ST, Zip: Lo
Telephone: 3 (, b — 7 ell bo
State Lic. # : j Q
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 9— � f 7 �4 %
Estimated Value of Project /!5, p oo
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2" Review, ready for correctionstissue
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
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