05-5278 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,- CALIFORNIA 92253
Application Number: —05-00005278
Property Address: 80752 VIA PUERTA AZUL
APN: 762-240-003-23 -300962-
Application description: POOL - RESIDENTIAL
Property Zoning: MEDIUM DENSITY RES
Application valuation: 20000
c&1,!t44Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
----------------Wtham
----------------------------
CONTRACTOR'S DECLARATION
I hereby affir under penalty of perjunsed under provisions of Chapter 9 (commencing with
Section 7 0 1 of Di ision 3 of the Bessionals Code, and my License is in full force and effect.
Licens ` s : CS - CLicenseNo.: 658996
IA -, . \
( \ OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I a 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 1$500).:
1 _ 1 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.).
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
Owner:
STUBBLEFIELD MIKE
80752 VIA PUERTA AZUL
LA QUINTA, CA 922.53
Contractor:
FAMILY POOL
P 0 BOX 283
LA QUINTA, C.
(760)564-365
Lic. No.: 65
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/01/05
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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.
XI 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 pof ,y number are:
Carrier STATE FUND Polic tuber 1344032-2005
_ I certify that, in the perforinahce work for which this permit is issued, I shall not employ any
person in any manner o become subject to the workers' compensation laws of California,
an agree that,TWKERS'
me subject to the workers' compensation provisions of Section
/ 00 of the La fo with comply with those provisions.
,cant
WARNING. FAILURE TO SECUCOMP ATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CLTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS($100,000). IN ADCOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOST, 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 omes null and void work is not commenced
within 180 days from date of issuance of su pe mit, or cessationf work for'180 days will subject
permit to cancellation.
1 certify that I have read this application and state th4ey
abo a information i correct. I agree to comply with all
city an co ty o diryM1ces and state laws relating t, onstruction, a hereby authorize representatives
of this tyy y fp er upon the_above-mentioned pr in;pection pu oses.
(Applicant or
Application Number . . . . . 05-00005278
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee 207.00 Plan Check Fee 134.55
Issue Date Valuation . . . . 20000
Expiration Date 5/30/06
Qty Unit Charge Per Extension
BASE FEE 45.00
18.00 9.0000 THOU BLDG 2,001-25,000 162.00
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Permit . . . MECH POOL
Additional desc .
Permit Fee' 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date 5/30/06
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE >100K 11.00
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Permit . . . ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation 0
Expiration Date 5/30/06
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING.POOL 30.00
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Permit PLUMBING
Additional desc . .
Permit Fee . . . . 33.0.0 Plan Check Fee 8.25
Issue Date Valuation . . . . 0
Expiration Date .5/30/06
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
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Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
LQPERMIT
Application Number . . . . . 05-00005278
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Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 311.00 .00 .00 311.00
Plan Check Total 160.55 .00 .00 160.55
Grand Total 471.55 .00 .00 471.55
LQPERMIT
APPROVED
FOR CONSTRUCTION
SCALE: APPROVED BY: _ _ DRAWN BY _�) d,, �.
DATE: sf / .3i%Q;� 4. !)%�n
REVISED
9076;k ) er> , /-,t CA 9zzs3
DRAWING NUMBER
R
Bin #
City of La Quint'a
Building 8t Safety Dllrislon
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Pennit #
Project Address: I/g
Owner's Name: ►,,Q
A. P. Number
Address: ' ,� L
Legal Description:
City, ST, Zip:��
Contractor:
Telephone: r Y
,;.N
Address: , D \
Project Description: L S A
City, ST, Zip: LA LA.114N dfOf -2-�
a.
Telephone: 'y.»�:•F SR
State Lic. # : b City Lic. #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone: ,� • : �.. �l i
State Lic. #:
Name of Contact Person: Q n
Construction Type: Occupancy:
ProJect YPcircle one): New Add'n Alter RepDemo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 010 Z-5 3
Estimated Value of Project: xb
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'.d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
I
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calls.
Called Contact Person
Plan Check Balance
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading pian
21 Review, ready for correctionsrssae
Electrical
Sabcontactor Lint
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. App al
Plans resubmitted
Grading
IN HOUSE:-
3" Review, ready for correctionsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees