11-0190 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:11-00000190
Property Address:
47360 VIA7RAVENNA
APN:
643-100-006-185 -26152 -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
22921
Applicant:
r
LICENSED CON
I hereby affirm under penalty of rjury that I am licensed
Section 70001 o Division 3 of a Business and Professio
LicenseC ss:' '53
ate: tracto -
Architect or Engineer:
ri l A,
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
IL
Owner:
BATTRAM-KENNETH &,DENIS
35 BODEGA BAY 'DRIVE
CORONA DEL MAR, CA 9262
Contractor:
AMERICAN HERITAGE POOL
PO BOX 11996
PALM DESERT, CA 92255
.(760)340-2588 -
Lic. No.: 945084
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/23/11
,CTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
ar pr isions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one, of the following declarations: '
o and my 'cense is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
e o.: 9 084 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 `
)ER DEC ATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Co r tor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any ' y 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`Icommencing 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, is 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 sate. 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.).
(_ I 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
Carrier EXEMPT y Nu EXEMPT
I certify that, in the perf ance of th wor or ich this permit is issued, I shall not employ any
person in any ma er so as to be me s je to a workers' compensation laws of California,
and agree that,' I should beco a s8bje t Wkers' compensation provisions of Section
0 e or o, s I forthw' c with tho provisions. '
,�`/�--
WARNING: FAILURE TO SECUR RKERS' COMPENSATION COVAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN 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 an hold harmless the City
of La Quinta, its officers, agents and employees for any act c omission re t 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 i wo isommenced
within 180 days from date of issuance of such or cessation o w for 8 days will subject
permit to cancellation.
I certify that I have read this application and state t t the above infor ation is c e . I ree o comply with all .
city and county ordinances and state lawsr ' ing constr tion, a r y a ori representatives
of this cou y to 1pnter upon the above -mend roperty a on po ,
Date: Si [ure (Applicant or Agent).
F
Application Number.. ... . 11-00000190
Permit MECH POOL .
Additional desc .
Permit Fee 26.00 Plan Check Fee 6.50
Issue Date Valuation . . . . 0
Expiration Date . 8/22/11
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE >100K 11•.00
' GltiFJll0.l.1 V11 L0.l.G -O� LLQ 11
Qty Unit Charge Per
Extension -
BASE
FEE
45.00
21.00 9.0000 THOU BLDG
2,001-25,0'00.
189.00
Permit PLUMBING
Additional desc .
Permit Fee . . 18:00
Plan Check Fee,.
4.50
Issue Date
Valuation
0
Expiration Date 8/22/11
Qty- Unit Charge Per
Extension
BASE
FEE
15.00
1.00 3.0000 EA' PLB GAS PIPE 1-4 OUTLETS
3.00
-------.--------
. Special Notes and Comments
POOL REMODEL: ADD TANNING SHELF,
NEW
EQUIPMENT (PUMP, FILTER, HEATER),.SALT
SYSTEM &•AUTO CONTROLS. 2010 CODES.
Other Fees . . . . . BLDG STDS-ADMIN (SB1473)
1.00
Fee summary Charged
Paid
Credited
Due,
Permit Fee Total 278..00
.00 .00.
278.:00
Plan Check Total 163.10
.00 .00
163.10
Other Fee Total 1.00.
.,0.0 .00
1.00
Grand Total 442.10
.00„ .00
442.10
LQPERMIT..
Bin #
City of La Quinta
Building 8T 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: �^ 40 F1— ue_iu OF
Owner's Name: 3�11 /U\
A. P. Number:
Address: �--3 6 d i A_R-
Legal Description:
City, ST, Zip: '
Contractor:Telephone:
PV
N
Address: _D,�j�t IIS�j(,
Project Description: eLr''
City, ST, zip:
W-0 U Ipm ei —
Telephone: - 2-558
:$;;<t<??s:..:z<;. <:::>::::::<:>> ;::<.;;: <:<;:>r; •;
— � l -
State Lic. # : City'Lic..#
Arch., Engr., Designer: a 5
Address: ��L� T� '� "1 C= Q 4- 13 t)
1.0i V0 L5
City, ST, Zip:
�-7
Telephone: Z' ' `� II
::':.;r•r;�:•t::w:33::Y:•�::.:.::::: ..'.
1 ::>l:: •::<k::.,.:.>..w,,<•s»:::<.....
<:;`r:z«:W:>::;::<:::..:< :::..,:.: 4..:;
'<`:?:'•.
Construction Type: I Occupancy:
State Lic. #: 3 N Ci
3
Project type (circle one): New •Add'n Alter Repair Demo
Name of Contact Person: ( e—
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: a — gj (70
1 Estimated Value of Project: q' Z1
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Z
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" 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
fN HOUSE:-
''a 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
NOTES
EAI Sit I Auiel. -LL-•Iseb trnllivly ;
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—73 STUB
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& SEE NOTES:
; . r
i/ CITY OF LA,QUINTA SUB -CONTRACTOR. LIST
JOB ADDRESS 36/0lcornl �%
PERMIT NUMBER 'O'WN'ER -BUILDER
This form shall be costed on the job with the Building Inspectiori Qardat all tunes in a consbicuous, place. Only'pers6ns appeasing on this list or their. employees are -authorized to work
'on this job. Any changes to this list must be approved .. by the Building I Division' -prior to commencement of work. Failure to comply will result in a itoppage of, work and/or the voidance.
I; k I + A 11 . 4 .4 " I &I + o' + ki es ^noel,
building DUIldg permit. For each app ca e a e, a V1 I I IC3 L U" I Vq VZ) V V ow must V.kV111Fj ere
y 0 LG"L.is-no Q%cvv U
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Company Name
Classification
License Number
Up. Date
Carrier Name
Policy Number
Exp. Date
License Number,
D�te
.,,Ex Date
(e.g. A, B -C-8)
(xx xxxx)
(xx/xx/xx)
Ie.g. State Fund, CalComp),
(Format Varies
4! da
(xx/xx/xx)
(Xxxx),
(xx/xx/xx)
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