12-0155 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000155
Property Address:
80907 VIA PUERTA AZUL
APN:
762-240-003-20 -300961-
Application description:
POOL - RESIDENTIAL
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
22000
Applicant:
T-4'� 4 4v Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
STEWART SHEARS
80907 VIA PUERTA AZUL
LA QUINTA, CA 92253
Contractor:
RAMMELL CONSTRUCTION
1800 EXECUTIVE DRIVE
PALM SPRINGS, CA 92262
(760)320-7010
LiC. No.: 665655
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/23/12
D 6 ��
FEB 2 20-12 1
CITY OF LA gUINTA I
----—------------------------------------------------------—-=--------------------------——-------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed 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 Business and fessionals 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
License Class: C53 License N .665655
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
''''7� ?
issued.
Date: G 2 / —/contractor: —'
_ 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
OWNER -BUILDER DE ON
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 AMERICAN ZURICH Policy Number WC966126500
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in tAerfmancc of [he work 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 anyo become subject [o the rkers' 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 thaecome subject tot orkers' compensation provisions of Section
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
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
3700 of the Lhall forthwithcoywith those provisions.
Jany
Date: Z -; �j caI,
as owner of the property, or my employees with wages as their sole compensation, will do the work, andthe
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECRS' COMPENSATION VERAGE IS LAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TOENALTIES 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 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.I.
Lender's Name: _
Lender's Address:
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 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 ' formation is correct. I agree to comply with all
city and county ordinances and state laws relating to building struction, and hereby authorize representatives
of this county to enter upon the above-mentioned property r ', spection purposes.
Date: �3� i nature (Applicant or Agent):
Application.Number . . . . . 12-00000155
Permit MECH POOL
Additional desc . .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation 0
Expiration Date . . 8/21/12
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE >100K 11.00
----------------------------------------------------------------------------
Permit BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 225.00 Plan Check Fee 146.25
Issue Date . . . . Valuation . . . . 22000
Expiration Date 8/21/12
Qty • Unit Charge Per Extension
BASE FEE 45.00
20.00 9.0000 THOU BLDG 2,001-25,000 180.00
----------------------------------------------------------------------------
Permit ELEC POOL .PERMIT -RES
Additional desc . .
Permit Fee . . . . 45.00 Plan Check Fee 11.25
Issue Date . . . Valuation . . . . 0
Expiration Date . . 8/21/12
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 . . . . 27.00 Plan Check Fee 6.75
Issue Date . . . . Valuation . . . . 0
Expiration Date 8/21/12
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 6.0000 EA PLB FIXTURE 6.00
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
NEW SPA EDITION TO EXISTING POOL.
LQPERMIT
Application Number . . . . . 12-00000155
----------------------------------------------------------------------------
Special Notes and
Comments
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. 2010 CODES.
-------------------------------------------------------------"---------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid
Credited
Due
-----------------
Permit Fee Total
--------------------
323.00
.00
---------=----------
.00
323.00
Plan Check Total
170.75
.00
.00
170.75
Other Fee Total
1.00
.00
.00
1.00
Grand Total
494.75
.00
.00
494.75
LQPERMIT
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Bin.#
Cray 0, La Quieha.
Building &r SafetyDivision :' -. , , ., .. .
P.O. Box 1504, 78-495.Calle Tamplco
La.Quinta, CA 92253-(760) 77T7012
Building Permit Application and Tracking Sheet
Permit #
Project —
Owner's Name:. J
ctrt
A. P. Number.
Address: i
Legal Description:
Contractor.
City, ST, Zip: ! G�
Telephone Gt'':"�"wss ;
f
Address:O _
Project Description: A
City, ST, Zip: ti 1 V n.'c• i r\
1 2 ��• � r
Telephone:
State Lic. # :46,56 City Lie. #; L
,
f
Arch., Engr., Designer
Address:Ls
City., ST, Zip:
Telephone:V
rtw j» :ry '
Construction Type:. Occupancy:
State Lic. #:
Project type (circle one): New dd' Alter Repair Demo
Name of Contact Person: S a
Sq. Ft.:
F-snes:to
#Units:
Telephone -01 of Contact Person:
Estimated Value of Project O
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd'Rec'd TRACICYIVG PERMTr FEES
Plan Sets
Plan Check submitted
h �,
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mecharilcal
Grading plan
2iJ Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
ICY HOUSE.-
'"' Revtew, ready for corrections/issue
Developer Impact Fee
Planning Approval.
Called Contact Person
AJ.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees