05-4357 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
z
22,
Applicant:
05-00004357 f
80764 VIA PUERTA AZUL
762-240-003-21 -300962-
POOL - RESIDENTIAL
MEDIUM DENSITY RES
20000
T4'!t 4 4& Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
REINDERS, REINT
80-764 VIA PUERTA AZUL
LA QUINTA, CA 92253
Contractor:
Architect or Engineer: FAMILY POOL CONSTRUCTI
WCC: STATE FUND
WC: 1344032-2005
CSLB: 658996
UC D CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjur th m licensed under provisions of Chapter 9 (commencing with
Section COAof D' ision 3 of the Bu si Professionals Code, and my License is in full force and effect.
LiceAse glass:) h . A License No.:
1 I OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I a xempt 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).:
(_) 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 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
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 maimrd
rkers' compensation insurance, a quired by Section 3700 of the Labor
Code, for the pertn of the work for which ermit is issued. My workers' compensation
insurance carrierolic umber are:
Carrier C53-HIC Polic mber---------------
I certify that, in the p orman o e work for which this permit is issued, I shall not employ any
person i any mann so becomesubject to the workers' compensation laws of California,
nd ee that, if I e subject to the workers' compensation provisions of Section
of the Labor o e. 11 fo 'th comply with those provisions.
'V
Da Applicant:
1
WARNING: FAILURE TO SECURE WORKE ' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENPA,LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE LOST 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 ermit.
2. Any permit issued as a result of this plication ecomes nu fid void if work is not commenced
within 180 days from date of i*gent):
i r cessation of work for 180 days will subject
permit to cancellation.
I certify t t I ve r d this application and information is correct. I agree to comply with all
city and c unt or ' antes and state laws rnstruction, and hereby authorize representatives
;ate:
thi;-6.0 ty t ter upon the above-mentspec purposes.
oignature (Applicant or
R
Q
LQPERMIT
Application Number . . . . . 05-00004357
Permit . . .
BLDG -POOL PERMIT
Additional desc . .
Permit Fee . . . .
207.00 Plan Check Fee
134.55
Issue Date
Valuation . . .
. 20000
Expiration Date
3/27/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
162.0.0
Permit . . .
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
3/27/06
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
3/27/06
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
3/27/06
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
----------------------------------------------------------------------------
Special Notes and Comments
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
Application Number . . . . . 05-00004357
----------------------------------------------------------------------------
Special Notes and Comments
BE IN PLACE
PRIOR TO PRE -PLASTER
INSPECTION.
EQUIPMENT ENCLOSURE NOT
INCLUDED IN
PERMIT.
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
i
LQPERMIT
CITY OF LA QU.INTA
4 BUILDING & SAFETY DEPT.
PPROVED
FOR CONSTRUCTION
DATE
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Bin#
City of La Quinta
Building 81 Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
OSS �35�.
Project Address: V
Owner's Name:
A. P. Number:
Address:06 V
Legal Description:
Contractor:'"
City, ST, Zip:
Telephone: � � As
Address:
Project Description:
City, ST, Zip: Qk-
61
Telephone: a
�-
State Lic. # :
Arch., Engr., Designer:
City Lic. #:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# St ries:
# Units:
Telephone # of Contact Person:
Estimated Value of Projec
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/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:-
d'd 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