08-0404 (RPL)P.O. BOX 1504 .
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN':
Application description
Property -Zoning:
Application valuation:
Applicant:
08-00000404~_- 4
78860 WAKEFIELD CIR
604-423-011-78 723995 -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL'
25000
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SIMON TROSSBACH
78860 WAKEFIELD CIRCLE
LA QUINTA, CA 92253 1
Contractor:
CALIFORNIA POOLS & SPAS
3106 E..GARVEY AVENUE SI
WEST,COVINA, CA 91791
(760)771-6141 '
LiC.'No.: 185102
VOICE (760) 777-7012
FAX '(760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/06/08
- 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 ass: B C53 Lice No.: 185102
"
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ate:: tractor: / OO L -s
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
. - 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 ARCH INS CO Policy Number ZAWCI9090400
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 workers' 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 that, if I should become subjec the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labo Code, I s fort h 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ate:-
(_ 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
WARNING: FAIL E TO SECURE WORKERS' COMPS ION 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 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.).
APPLICANT ACKNOWLEDGEMENT
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 contractors) 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 Quinta, 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 such permit, or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a constructionlendingagency for the performance.of the
I certify that I have read this application and state that the above information is c I agree to comply with,all
. • work for which this permit is issued (Sec. 3097, Civ..C.).. -
city and county ordinances antl state laws relating to bui uction, hereby authorize representatives _
_
,..
of this cou [y to ente�upon above-mentioned property for in�pe rposeLender's
Name:
— -Dater �� i SApplicant or A
Lender's Address:'
.
LQPE• Rn4IT
Application Number .
. . . .. 08-00000404
/
- Permit . ". . . . .
BLDG POOL PERMIT,
Additional desc
Permit Fee'.
252.00 '. Plan Check Fee
163.80
Issue Date
Valuation
24892
Expiration Date
9/02/08
Qty Unit Charge
Per
Extension
BASE FEE
45.00
23.00 9.00007HOU
BLDG 2,001-25,000
207.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation
0
Expiration Date
9/02/08
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 .
9/02/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
EA ELEC.PRIVATE SWIMMING POOL
30.00
Permit . .
PLUMBING c
Additional desc .
Permit Fee
33.00 Plan Check Fee
8.25
Issue Date
Valuation
0
Expiration.Date
9/02/08
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
1.0.0 3.0000
EA PLB GAS PIPE'1-4 OUTLETS
3.00
Permit
WALL/FENCE PERMIT
c.
LQPERMIT
.
Application Number 08-00000404
Permit . . . WALL/FENCE PERMIT
Additional desc .
- Permit Fee 15.00 Plan Check'Fee.
.00
Issue Date . . . . Valuation',..
108
Expiration Date'. 9/02/08
Qty Unit Charge Per
Extension
BASE FEE
.15.0.0
--------------------------
Special Notes and Comments
POOL/SPA, 5 L.F. 5' EQUIPMENT WALL, CITY
STAIMARD. ALARI!IS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION.
Fee summary Charged Paid Credited
Due -
Permit. Fee Total 371,.00 .00
.00
371.00
Plan Check Total 189.80 00
00
189.80
Grand Total. 560.80 .00
.00
560.80
LQPERD1IT ..
Bin #
City of La Quinta .
Boilding & Safety Division
P.O. Box 1504, 78-495 Calle Taripico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and T.-acking Sheet r
Permit #
-Project Address:' '799(ob< a ,eTieCr.
Owner's Name: 1 -77 SSbG+�
A. P. Number:
Address: 'egg (ob
Legal Description:
City, ST, Zip:-
Contractor:�l� r s
Telephone:'
Address: ��
Project Description:
City, ST, Zip: S�
00 L :�6, es.SALL
Telephone: ��p-77�_��
State Lic. # : �� sc—/ O.�?_ City Lic. #:
Arch., Engr., Designer: � �.� � OOLS�
� C 6 CL
Address:
City, ST, Zip: C� u
Telephone: NIMBI - a
State Lic. #:
Name of Contact Person: J ✓e
Construction Type: Occupancy:
Project type (circle one . New)Add'n Alter . Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 76(0 77/-
Estimated Value of Project: 000
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING ,
PERNUT 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
M•^.chanical
Grading. plan
2"d Review, ready for corrections/issue
EI.°ctrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Leading
IN HOUSE:-
''d 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
Tonal Permit Fees