05-5380 (RPL)P.O. "BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX'(760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153,
.. BUILDING PERMIT
Date: 12/09/05
Application Number:.,c'05=0000 0 Owner:
Property Address: 57377 VIA VISTA ROGER$
APN: 762-240-003-27 -300962- 52-377 VIA VISTA
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning:' MEDIUM DENSITY .RES
Application valuation: 20000
Contractor: ,
Applicant: Architect or Engineer: FAMILY POOL CONSTRUCTION
P 0 BOX. 283 JAN, 0 52006•.
A QUINTA, CA9
2247
-3655
!{%
•
Lic: No 658996` CITt(OFlaeiOlt814dTi�
FtNAE10E DEPT. • ,
---------=-- — — —- — - —- -- --_ — — — — — —— --- --
LICE ED CONTRACTOR'S DECLARATION - - WORKER'S COMPENSATION -DECLARATION - -
hereby affirm -under penalty of perjury that I license provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
• Section 7000 of ivision 3 of the Business a ss]onals 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
Licens;�Wontrac.,----
HIC - License No.: 658996 - for by Section 3700 of the. Labor Code, for the performance of the work for which this permit is :
.. • - issued.
te:],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- UILDER DECLARATION - - insurance carrier and policy number are: .
- I hereby affirm under penalty of perjury that am exempt from the Contractor's State License Law for the Carrier STATE FUND � - -Policy Number' .1344032-2005
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to - _ _ Lcertify that, in the performance of. the work for which this permit is issued, Fshall•not employ any :
construct, alter, improve,. demolish, or repair any structure, prior to its issuance, also requires the applicant.for the - -
person in any manner so a o'bec a subject to the workers' compensation laws of California,
permit.to filea signed statement,that he or she is licensed pursuant.to the provisions of the Contractors State - and agree that, if I should a subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division of .the Business and Professions Code).or. - 3 0 of the Labor 11 forthwith comply with those provisions.
that he or she is exempt therefrom and the basis. for the alleged exemption. Any violation. of Section 7031.5 by //C
.any applicant for a permit subjects the applicant to a civil penalty of not more than. five. hundred dollars ($500).: - te: Applicants )�
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 WARN G: FAILURE TO SECURE WORD RS' CO PENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL NALTIES 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 offeredforsale. -1f, however, the building or improvement is sold within ` SECTION 3706 OFTHE 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.). - - - - APPLICANT ACKNOWLEDGEMENT' -
(' 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. - IMPORTANT Application is hereby made to the Director of Building and Safety for a permit, subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. -
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made,.each person at whose request and for "
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
( 1 I am exempt under Sec. - , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
- . of La Quints, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
Date:. .Owner: - - 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 su permi sation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY - permit to cancellation.
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state tha a oJe information is correct. I agree to.comply with all•
work for which this permit is issued (Sec. 3097, Civ: C.1. - city and c nt ordinances and state laws relating to onstruction, and hereby authorize representatives ,
• - - _ of this cou t o nter upon the above-mentioned pr f spaction purposes. '
Lender's Name: ' /9 �.
Date Signature (Applicant or Age trf 1:
Lender's Address: -
LQPERMIT - '
Application Number 05-.00005380
Permit BLDG .POOL PERMIT
Additional desc' .
Permit Fee 207.00 Plan Check.Fee
134.55
Issue Date Valuation
2000.0
Expiration Date 6/07/06
Qty Unit,Cbarge 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 . 6,/07/06
Qty, Unit Charge Per
Extension -
BASE FEE1500.;-
1.0,0 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- 6/07/06
Qty wUnit Charge' Per
Extension
-BASE .FEE
15.00,.."
100 30.00-00 EA.- ELEC PRIVATE SWIMMING-POOL.
30.00
Permit . `.. .. . PLUMBING:
..
Additional desc ..
Permit.Fee 33.00 Plan Check Fee,
8.25
8.25
- Issue Date Valuation.
0.
Expiration Date _ 6/07/06
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 ;
LQPERMIT ,. -
i
Bin #.
City Of La QuInt'a
Blrilding &r Safety Dlvlslon
P.O. Box 1504, 78-495 Calle Tampico
to Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
permtt # ®.
DS - fo
Project Address: �j 3 7-7
Owner's Name o 0 ' �S
A. P. Number.
Address: 5:7-S:Z:7
Legal Description:'
Contractor:
Contractor: � � St' , �
City, ST, Zip: L,(4 -
Telephone: '��::��•:•:.; ' '
Address: Ol �
Project Description: S
City, ST, Zip: LA Owkkp, z2 -g.5
Telephone: -
• •.�. .�.:r.:��•'•
:ti=•-�,�,� k�..�.'01;
-
State Lic. # : �� 1
City Lie. #:
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone: z;>W.
State Lic.#: - '- + ' :`
Name of Contact Person: ��
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL:
# Stories:
# Units:
Telephone # of Contact Person: �Z - �3 �,
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Pian Sets
Plan Check submitted
�,t/
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked Up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading pian
V Review, ready for correctionsrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked op
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IIY HOUSE::
7i1 Review, ready for correctiondissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees