13-0506 (RPL):��V.
P.O. BOX 1504''
7.8-495 CALLS TAIVIPICO r
LA OUINTA, CALIFORNIA 92253 BUILDING & SAFETY' DEPARTMENT
BUILDING PERMIT
Application Number:
Property Address:
APN:
Application description
,.Property Zoning:.
Appliootion 'aoluotion: .
Applicant:
lY
13-00000506.
78995 WAKEFIELD CIR
604-422-003-11 -23995
POOL'- RESIDENTIAL
LOW DENSITY RESIDENTIAL
11000
Architect.or Engineer:
Owner:
BRIAN BOWEN.
78995 WAKEFIELD CIRCLE
LA OUINTA. CA 92253
Contractor:
COMPETITIVE WEST POOL
PO BOX 5865
LA.QUINTA, CA 92248
;(760)625-2512
Lic. No.: 916827.
VOICE (760) 771-7012-1-
FAX
77-7012;FAX (760) 777-7011
INSPECTIONS (760) 777-7153'
Date: 4/23/13.
DPI:
D
CC]R AP..24E2:013
P
CITY OF LA QUINTA
FINANCE DEPT
' LICENSED CONTRACTOR'S DECLARATION _
WORKER'S COMPENSATION DECLARATION
Ihereby-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 andeffect.
_ I have and will maintain a certificate of consent to, self -insure for.workers' compensation, as provided
. License CI s: C License No.: 916827
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 .
' ER -BUILDER DECLARATION-
insurance carrier and policy number are:
I hereby affirm under penalty of perjury th am exempt from the Contractor's State License Law for the
Carrier PRAETORIAN INS Policy Number 497050553611
' 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 repairany structure, prior to its issuance, also requires the applicant for the
pdrson in any.manner so as to become subject to the 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 subject to the workers' compensation provisions of Section
License Law. (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3 0 of the Labor Code, I shall f with 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).: ' '
Q
Date: Z e1pplicant:
I, as owner of the property,.orrmy employees with wages as their solecompensation, will do the work, .and.
the structure is not intended or offered for sale (Sec, 7d44, Business and. Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' NSATION•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 PENAL SAND 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 1$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 -
(_ 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.l.
.whose benefit work is performed under or pursuant to any. permit issued as a result of this application,
I am exempt under Sec. " , B.&P.C. for this reason 1
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 isnot 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 construction lending agency for the.performance of the
I certify that I have read this. application and state that the above information is correct. I agree to comply with all
work for which.this permit is issued (Sec. 3097, Civ. C.)., .
city and cou y ordinances and state laws relating to building constru nd hereby authorize representatives ,
' -
' Lender's Name:
of this cou to ter upon theabove-mentioned property for insp ion purposes.
. .
\ -
1
Date:. �/ nature (Applicant or Agent):
Lender's Address:
. A `
1' ..
1
•
t
L.QPERMIT ..
_
I'
^� A.
LQPERMIT
Application Number . . . . . 13-08800506*
`
' Permit . . ' . . .
MEco rooL ^
Additional deao .
Permit Fee . . . .
26.00 eIau cbeob Fee
6.50
Issue Date . . . .
Valuation . . .
. n
Expiration Date . .
10/19/13
Qty Unit Charge
Per
Extension
BASE FEE .
15.0o.
1.00 11.10000
-------------_----------------------------------
Eu' MECeFURNACE ^zOOK
-----------------------------
11.09.
Perm t . . . . . .
BLDG POOL PERMIT
Additi—onal deno . .
Permit Fee . ' . .
1s3.00 Plan Check nee .
. 99.45
Issue Date . ' . .
' Valuation . . `
. 13675
Expiration Date . .
10/20/13
Qty Unit Charge'
Per `` ^~ ^^`
- 'Extension
BASE FEE
45.00
12.00 9.0000
------------'-------------------
THOU BLDG 2'001-25'000
---------------------------
108.'00
-------
Pezmit ' . ' . . .
ELEC POOL PERMIT -RES
. Additional deac ' �
Permit Fee . . . .
45.00Plan Check Fee .
. 11'25
zooue Date . . . .
vaIoatiou . . .
. V
Expiration oate . -
10/19/13 .
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
------------------------------------------------------~---------------------
Eu ELoCPazvArE GwIMmzmG POOL
30.00
. gezmit . . . . ' .
gLDnmazmG
Additional deoc' .
Permit -Fee ' ` . .
33.00 Plan Check Fee .
' 8'25
zaooe Date . . . .
Valuation . . .
. 0
Expiration Date . .
'
'
.10/19/13
�
��y �D�i� C�a�ge
�e�
^ `
Eztenoioo
aaoE
1s.00
2.00 6.0000
EA pLB FI�KTURE
12. 00
1.00 3.0000
EA PLB vmxrER zmST/ALT/REP
3.00
1.00 3.0000
----------------------------------------------------------------------------
Eu gLB GAS PIPE 1-4 OUTLETS
eezmit ' ' . ' ' ' WALL/FENCE PERMIT
Application Number . . 13-0000050'6
Permit . . . . . . WALL/FENCE PERMIT ,
Additional desc :
Permit. Fee 15.00 -Plan Check. Fee
.0.0
Issue Date: . . . . Valuation
325
Expiration Date'. 10/20/13
Qty Unit ..Charge Per:.
Extension
BASE FEE
15.00
__
Special Notes and Comments
POOL, EPA, ISLE' AT 5 FOOT HIGH EQUIPMENT
WALL [1 INCH GAS PIPING]. ALARMS AND
- BARRIERS REQUIRED TO BE INSTALLED'AT
PRE -PLASTER INSPECTION. 2,010 CALIFORNIA
BUILDING CODE.
Other.Fees . . . . BLDG STDS ADMIN (SB1473).
1.00
Fee summary: Charged Paid Credited
Due
:Permit Fee Total 272.00 104.00._ .00.
1.68.00
Plan Check Total- 125.45 26.00 -00
99..45
Other Fee Total 1.00 1.00• .00
.00
Grand Total 398.45. 131:0.0 .00
267.45
LQPERMIT -
..
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000506
Property Address: 78995 WAKEFIELD CIR
APN: 604-422-003-11 -23995 -
Application description: POOL - RESIDENTIAL -
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 13675
Applicant: Architect or Engineer:
Lzw
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
Owner:
BRIAN BOWEN
78995 WAKEFIELD CIRCLE
LA QUINTA, CA 92253
Contractor:
COMPETITIVE WEST
PO BOX 5865
LA QUINTA, CA 922
(760)625-2512
Lic. No.: 916827
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-71-53'
Date: 4/22/13
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
1 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: C53 License No.: 916827
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�f ( -
issued.
_
Date: `l _�� 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
NER-BUILDER DECLARATION
�am
insurance carrier and policy number are:
I hereby affirm under penalty of perjury t empt from the Contractor's State License Law for the
Carrier RAETORIAN INS Policy Number 497050553611 _
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
C ,---j_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 the workers' compensation laws of California,
. permit tofile 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 subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3 O0 of the Labor Code, I sh rthwith 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 1$500).:
Date: Applicant:
(_) 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: AILURE TO SECURE WOR 'COMPENSATION 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 CRIMIN 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
1 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 result of this application, -
)A 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 -
_-1_
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 ofperjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). .. -
city and county ordinances and state laws relating to building construction, and hereby authorize representatives ..
-
of this coWtyp enter upon the above-mentioned property
.Lender's Name: �
=Urposes.
-
-. - - - -
Date:- - ?a/ Signature (Applicant or Agent):
Lender's Address:
�.. -
LQPERMIT - -
Application Number . . . 13-00000506,
Permit 'MECH POOL
Additional desc
Permit Fee 26.00 Plan, Check Fee-.
6.50,
Issue Date Valuation
0 .
Expiration Date .. 10/19/1,3
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 10/19/13.
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 10/19/13
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 I INST/ALT/REP
3.00
1.00 - 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
Special Notes and Comments
POOL,: SPA, 15LF AT 5 FOOT HIGH EQUIPMENT
WALL [1 INCH GAS ,PIPING)• ALARMS AND
BARRIERS REQUIRED TO BE INSTALLED AT
PRE -PLASTER INSPECTION. 2010 CALIFORNIA
BUILDING CODE.
------------------------------------------ ---------------------------------
Other Fees . . . . BLDG STDS ADMIN (SB1473)
1A0
Fee ,summary Charged Paid credited
Due
Permit Fee Total 104.00 .00 .00
104.00
Plan Check Total 26.00 .00 .00
26.00
LQPERD1IT f
Bin #
Permit #
l$ - Tb
Project Address:
A. P. Number:
Legal Description:
Contractor.
Address: Po BDX .5865
City, ST, Zip: 4 E►J U/A/ii
Telephone: (Z.S- a:51 Z
State Lic. # :
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: C i*Rts"
Telephone # of Contact Person '7 1
# Submittal
Plan Sets
Structural Cafes.
Truss Cafes.
Energy Cafes.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE:-
Planning
OUSE:Planning Approval
Pub. Wks. Appr
School Fees
City of La Quints
Building a Safety Division
P.O. Boz 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
akefiell) G`,eC e_ Owner's Name: fS,Q/q t -J -6 IJ
Address: -
City, ST, Zip: /14 0 U i 1^ 4,4
Project Description:
N ec,J
Lic. #: /04/803
(-14S , .kn' /
DA
Total Permit Fees
Construction Type: 6cm.11 c- Occupancy:
Project type (circle one): New Acb'n Alter Repair Demo
r Co 6N P—
Sq. Ft:
# Stories:
# Units:
Estimated Value of Project:
6 00
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd
TRACKING
PERMIT FEES
Plan Check submitted
I
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
tad Review, ready for correcdons/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.L
Plans resubmitted
Grading
3- Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.LP.P.
Date r issne
DA
Total Permit Fees
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