05-5579 (RPL)r
P.O. BOX .1504
78-495 CALLE TAMPICO -
LA QUINTA, CALIFORNIA 92253
Application Number. 05=00005579, -
Property Address: 56877 V L1J M DR .
APN: 764 -050 -029 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 35000
Applicant: _
Architect or E
c&t!tfitrGv
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT 1' INSPECTIONS (760) 777-7153
BUILDING PERMIT
Owner: _-
STRUIKSMA EDWARD
56877 VILLAGE.DRIVE
LA-QUINTA, CA 92253
---------------------------------
Contractor: '
Owner
Date: 12/29/05
LQPERMIT
I
--------------7----7--------
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 Professionals 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:- - License No.:
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
-
` issued. -
Date: 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 DECLARATION
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 Policy Number
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
I certify that, in -the performance of the. 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 any manner so as to become subject to a workers' compensation laws of California, -
permit to file signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
d agree that, s become sub' to a orkers' comp ation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
700 of the Labor , I shall forth o p wi t p v ions. '.
that he or she. is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
S
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
tE�` plicant:
(_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
Y
the structure is not intended or offered for sale (Sec: 7044, Business and Professions. Code: The
WARNING: FAILURE TO SECURE WORKERS' COM N ATIO 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 PENALTIES 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 pr offered forsale. 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.).
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 u er Sec. . for this re n -
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
IOf -
of La Quinta. its officers. agents and employees for any act or omission related to the work being
j: 7� ry,4 -
performed under or following issuance.of this permit.
/
e: !r (% wner:
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 or 180 days will subject
- CONSTRUCTI N ND G AGENCY .
permit to cancellation.
I hereby affirm under penalty of perjury that there is a constru i len- ing agency for the performance of the
I certify that I have ead this application and state that the above information i cor . I a ree to comply with all
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work for which this permit is issued (Sec. 3097, Civ: C.).
city and co my or nan and state laws relating t ui_ construction n o rep ntatives
ofthi co ty to t upon the above-mentioned prop y inspection p s
. Lender's Name:
)�
�i ignature (Applicant or Agent):
Lender's Address:
LQPERMIT
I
Application Number
05-00005579.
Permit
BLDG POOL PERMIT
Additional desc ...
Permit Fee
317.00 Plan Check Fee
206.05 _
Issue Date
Valuation
35000
- - - - - _Expiration Date : -
6/27/06
. Qty Unit Charge
•Per
Extension
BASE FEE
.252.00
10.00 6.5000
THOU BLDG 25,001=50,000
65.00.
Permit . .
MECH POOL
Additional desc..
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date
Valuation
0
Expiration Date
6/27/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
------------------
EA MECH FURNACE >160K
11.00.
Permit
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . .
45.00 Plan Check Fee
11.25
Issue.Date•
Valuation . . .
. 0 °.
Expiration Date
6/27/06
Qty. Unit Charge
Per
Extension
BASE FEE,
15.06
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
6/27/06
Qty Unit Charge
Per
Extension
BASE FEE
15.0.0
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
340.
Special Notes and -Comments
POOL/SPA ONLY. 2 GAS
STUBS_FOR FUTURE
. LQFERMIT -
..
Bin #
- -.
City of La Quinta il ......... 11��
Building u 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:
A. P. Number:
Owner's Name: (P 0 51 ``IJ ( avnA
Address: G (-81 V6 .
City, ST, Zip:LPt u io
Legal Description:
Contractor:
Address:
City, ST, Zip:
Telephone:
State Lic. # : City Lic. #:
Telephone:
Project Description: Q p tP1.
w 0 GAS
c.la
x
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Peron: JM� Lw m F�
512 A Z. -PI 10 ,
Construction Type: Occupancy:
Project type (circle one) Ne Add'n Alter Repair ..Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 14 4 q 33
�-
Estimated Value of Project: r 000.
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal"
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
�a 9
Item
Amount
Structural Calc:.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Planspicked up
Construction
Floodplain plan
Plans resubmitted
Mechanical
Grading, plan
2°" Review, ready for corrections/issue
0
Electrical
Subcontactor L.st
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''"• Review, ready for corrections/issue
Developer Impact Fee
Planning Approval ,
Called Contact Person
A.I.P.P.
Pub. Wks. Appi
Date of permit issue
School Fees
Total Permit Fees
12/08/2005�.22 47 7605680324 AVAIL PROP MGT PAGE_ 01
ih-
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VILLAGE'AT THE. PALMS H.U.A. f .
AAvail Prope>r> y'Management
P.U. Box I032 r
fl. Palm Desert, CA 9226:,
760-569-27-17
M
December 9, 2005 1 .
Mr. Ed Struiksma y
56-877 Village Drive .
La Quinta, CA. 92253 ` 1.
RE: Architectural Variance Request
Dear Mr. Struiksma: { ;
Your,request for the installation of a swimming pool on your property was reviewed•and approved by the
Architectural Committee with the following conditions: .
All necessary City permits are obtained prior to work starting:
All construction rules (see attached) will be followed by your Contractor. s
• Any damage to the common areas during this construction will be your responsibility to- repair
' and/or replace.
x All required set backs are observed, Le, `...all poolslspas should be a minimum of 5 feet from all
property.lines and all hardscapes should,be a minimum of 3 feet from the rear property line..'.
Thank you, for your cooperation in this matter:
Sincerely,,, a 1
Cam Anderson '
Project Manager4
Y `4 + • i
40J, C
OF 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253
-TELEPHONE (760).777-7012 FAX (760) 777-7011
J
OWNERJBUILDER° INFORMATION
R t
Dear PropertyOwner:
An application for a building permit has been submitted "in your name listing yourself as the builder-of•the property
improvements specified.
• For your protection. you should be aware that as "Owner/Builder" you are the responsible party of record on such a •
permit. Building permits are not required to be signed by property owners unless they are.personally perforining their
ovvn work.. If your work is being performed by someone other than yourself, you mayprotect yourself from possible.
liability if, that person applies for the proper permit in his or her name: ,
Contractors are required bylaw.to be licensed and bonded by'the-State of California and to have a business license
from the City or,County. They are also required by law to put their license number on all permits•for which they
apply.
If you 'plan, to do your own work, with the exception of various trades that you plan to subcontract, you should'be k
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work -(including materials. r
and other' costs) -;is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may bean employer. ,
` If you am an employer, you must register with the State and Federal Government as. an employer and you are subject.
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation, insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks.for you if you do not carry out, these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
. you wish, theU.S..Small Business Administration). For more specific information about your obligations .under State
Law,.contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contracts are allowed to'perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent 'practice of unlicensed persons .professing to be contractors is'to secure an "Owner/Builder" building
permit, erroneously. implying that the property owner is providing his or her own labor and•material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally' i
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form 'so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours, -
CITY OF LA_QUINTA '
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quints, CA 92253. '
(760) 777-7012
A-9 0) 777
' OWNER'S SIGN T RE ATE
PROPERTY ADDRESS f
' PERMIT NUMBER(S) y
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB AD
D'FESS PERMIT NUMBER . OWNER BUILC
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or
on this job. Any changes to this list must be approved by the Building Division prior.to commencement of work. Failure to comply will result in
nf' h„ildinn. nermit- For each aoolicable trade. all information requested below must be completed by applicant: "On File" is .not an acceptable res
Trade /Classification
Contractor' ::
: <•r:<:.:.:;• .: •Stafe::Contractor s Uceltse .:..........:.
':W-4kes Compen5'etioi+risuianCe`:°`..:'
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
1e.9. State Fund, CalComp)
Policy Number
(Format Varies)
EARTHWORK (C-121 ...
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TRUCT: STEEL (C•51)
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MASONRY•(C-291
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C� t S-10
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DRYWALL (C-9).,-.".
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El.ltCTRICAL'(C-10)' ...:
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RQUFING. {91`39),>;..': > :'
$HEFT METAL (0=43)
FLOORING IC:16):.
GLAZING (C-17)-'
INSULATION(C-21.'
Q
SEWAGE 0lSp;.(C-442)
PAINTING (C41)
CERAMIC TILE(C-54)
CABINETS (C=6)
FENCING (C-13)'
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ro 20
LANDSCAPING ((427.1. ° .
C' C . C U X11 1 1=..
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V (o" & O k u (��
LIST -
_..ATRACTOR
vW(1fER..- BUILDER
.10icuous place, Only persons appearing on this list or. their employees are authorized to work. r '
mmencement of work. Failure to comply will result in a stoppage of
work and/or the voidance
`n leted
by applicant. "On File" is not an acceptable response.
..•.;<:.
r :.. :W4rkers.Com ensn:...:s.0
usie
Cit s
Licen. se:♦ ::
`
ip. Date
Carrier Name
Policy Number
Exp. Date
License Number '
Exp. Date
6/xx/xx)
(e.g. State Fund, CalComp)
(Format Varies)
(xx/xx/xx) .
(xxxx)
(xx/xx/xx)
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