08-1261 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08-00001261
Property Address: 80083 VIA TESORO
APN: 777-310-029- - -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 20000.
c&-t!t 4 4v4amrw
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CLARK RESIDENCE
80083 VIA TESORO
LA QUINTA, CA 92253
Contractor: D
Applicant: Architect or Engineer: TESERRA
P.O. BOX 1280
COACHELLA, CA 9
(760)398-9222
Lic. No.: 656128
LICENSED CONTRACTOR'S DECLARATION
1 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: CB C27 C29 License No.: 656128
Date: 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 MOO).:
(_ 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.).
1 _ 1 1. as nwner of the grggerty, am gxclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License LACI 6625 MOT 2pply TO 811 Owner Ur
property who builds or improves thereon, and who contracts for the projects with a contractorls) 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/24/08
Q 1i�
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1
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JUL 2 2
y.V �p QUINTA
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 SEABRIGHT Policy Number BB1080510
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 1 should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000) 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
wndiliuns eml reaulutluuu uvi ruill, on lNa 0130661;ail-
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 construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
Application Number . . . . . 08-00001261
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
207.00
Plan Check
Fee
134.55
Issue Date . . . .
Valuation
. . . .
19840
Expiration Date . .
1/20/09
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
18.00 9.0000
----------------------------------------------------------------------------
THOU .BLDG
2,001-25,000
162.00
Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . .
26.00
Plan Check
Fee
6.50
Issue Date . . . .
Valuation
. . . .
0
Expiration Date . .
1/20/09
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 . .
1/20/09
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 . .
1/20/09
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
Permit . . . . . . WALL/FENCE PERMIT
LQPERMIT
Application.Number . . . . . 08-00001261
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 15.00 P1
Issue Date . . . . \1
Expiration Date . . 1/20/09
Qty Unit Charge Per
an Check Fee . . .00
aluation . . . . 160
Extension
BASE FEE 15.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL, SPA, ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INPSPECTION. 10
L.F. X 48" CITY STANDARD EQUIPMENT WALL.
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 326.00 .00 .00 326.00
Plan Check Total 160.55 .00 .00 160.55
Grand Total 486.55 .00 .00 486.55
LQPERMIT
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Bin #
City of. La Quinta
Building & 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:
Owner's Name: AK/e-
A. P. Number:
Address:73
Legal Description: MOt4rdAliv l/(x-tj
Contractor: I <f serraTelephone:
City, ST, Zip:
Project Description:
Address:b--
'S
City, ST, Zip: e, 1
Telephone: q2�Z
CJ�qZ-236
V
State Lic. # : 2
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: &OS -- Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person: C7 p
0— UZ -9 1
Estimated Value of Project: 20 .— K
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 Calcs.
Called Contact Person Plan Check Balance
Energy Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2" Review, ready for corrections/issue Electrical
Subcontactor List
Called Contact Person Plumbing
PP
Plans resubmitTed Grading
OUSE:
--- - - - -- - - -- - . - - - - - -
Tannin A roval
Planning PP
- Celled Ciiritiict Pe�soo- ' - - ^ 'A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
N 0,