10-0528 (RPL)- ' P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: -°10-00000528
Property Address: 81411 PEARY PL
APN: . 767-680-023-
Application
67-680-023 Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 28000
wa�/ 4 4 Q"
Applicant: Architect or Enginee
�1a
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: - 6/17/10
Owner:
LARSEN TERRENCE A.
18363 CALLE STELLINA
RANCHO SANTA FE, CA 92091
Contractor:
e AZURE POOLS AND SPAS
P.O. BOX 10641
PALM DESERT, CA 92255
JUNO
1.no�o (760)322m7665
I1 O.[ Lic. No.: 802919
OF LA
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LICENSED CONTRACTOR'S DECLARATION
I 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 Clas : C53 License No.: 802919
1 ate: ntractor.
/ -
OWNERSUILDER DECLARATION
I ereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
'lowing 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 70001 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 riot more than five hundred dollars ($500).:
(_ 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for the projects with a contractor(s) licensed '
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempi 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: tit H
LQPERMIT
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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
1y issued.
![ I have and will "maintain workers' compensation insurance, as required by Section 3700 of the Labor
777"'��� Code, for the performance of the work for which this permit is issued. 'My workers' compensation
insurance carrier and policy number are:
Carrier DELOS INS CO Policy Number 03DKRMI2002794
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 $gbe that, if I should become subject to the workers' compensation provisions of Section
�`1�3) yA 0 the Labor Code, I ith comply with those provisions.
aD t - " scant: 1
TP—
WAR G: FAILUR T CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. 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
conditions and restrictions set forth on this application.
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 19 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 unty to enter upon the above -menti o ro y ff inspection purposes.
te: nature (Applicant or A ►y\
W
Application Number . . . . 10-000005.28.
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . 271.50 Plan Check Fee 176.48
Issue Date . . . Valuation . . . . 28000
Expiration Date 12/14/10
Qty Unit Charge Per Extension
BASE FEE 252.00
3.00 6.5000 THOU BLDG 25,001-50,000 19.50
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Permit MECH POOL
Additional desc .
Permit Fee 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date 12/14/10
Qty Unit Charge. Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE >100K 11.00
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Permit ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 75.00 Plan Check Fee 18.75
Issue Date Valuation . . . . 0
Expiration Date 12/14/10
Qty Unit Charge Per Extension
BASE FEE 15.00
2.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 60.00
----------------------------------------------------------------------=-----
Permit PLUMBING
Additional desc .
Permit Fee . . . . 42:00 Plan Check Fee 10.50
Issue Date . . . . Valuation . . . . 0
Expiration Date 12/14/10
Qty Unit Charge Per Extension
BASE FEE 15.00
3.00 6.0000 EA PLB FIXTURE 18.00
1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00
2.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 6.00
----------------------------------------------------------- ----------------
Special Notes and Comments
POOL/SPA, COURTYARD FOUNTAIN WITH
LQPERMIT
LQPERMIT
Application Number . . . . . 10-00000528
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Special Notes and Comments
DEDICATED EQUIPMENT. ALARMS/BARRIERS
SHALL BE IN PLACE AT PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED. 2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
2.00
Fee summary Charged Paid
Credited
Due
Permit Fee Total 414.50 .00
.00
414.50
Plan Check Total 212.23 .00
.00
212.23
Other Fee Total 2.00 .00
.00
2.00
Grand Total 628.73 .00
.00
628.73
LQPERMIT
Bin #
City of La Quinta
Building 8i: Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1p,
Project Address:
Owner's Name:—r Y
A. P. Number:
Address: (/
Legal Description:
City, ST, Zip: oilI /7
Contractor: lqzittscJ- slqu
Telephone:
Address:
dr
Project Description:
City, ST, Zip:
Telephone: _
State Lic. # : WOO
City Lie. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:`A-1-
Telephone:
i i':'s; - '>" '"""'> `% :.
ConstructionType: Occupancy:
State Lie. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
?j Q
Estimated Value of Project: 2-0
APPLICANT: DO NOT WRITE BELOW. THIS LINE
M
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cala.
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
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. Appr
Date of permit issue
School Fees
Total Permit Fees