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09-0751 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: ` 09_-00000751 Property Address: 53443 ROSS AVE APN: 767-200-998-32 -330761- Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 90000 Applicant: D�- fie ce Tity/ 4 4 Q" Architect or Engineer: P 1//' BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C29-053 License No.: 81_%52 T.✓�- a1 ate: ntractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following 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 7000) 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 not more than five hundred dollars ($500).: (_) 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.). (_) 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 ) I am exempt 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 ISec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT Owner: GOLDBERG 53443 ROSS AVE LA QUINTA, CA 92253 Contractor:CNUE LARA MASON82373 KENN''INDIO, CA 1L (760)702-5Lic. No.:� VOICE (7 60) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 D Date: 7/14/09 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 issued. 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 insurance carrier and policy number are: Carrier E CEMPT Policy Number EXEMPT 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 agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the abor Code, I shall forthwith comply with prOv' ' ns. Dat �ca Date: pplicant: / WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). 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 to 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. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby autho' sentstives of this county to enter upon the above-mentioned property f� n purposes Date:/y.4Q S' ature (Applicant or Agent): Application Number . . . . . 09-00000751 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . 15.00 Plan Check Fee 3.75 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/10/10 Qty Unit Charge Per Extension BASE FEE 9.75 7.00 -----------------=---------------------------------------------------------- .7500 PER ELEC.DEVICE/FIXTURE 1ST 20 5.25 Permit . . . MECH POOL Additional desc . Permit Fee . . . . 48.00 Plan Check Fee 12.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/10/10 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 ---------------------------------------------------------------------------- 11.0000 EA MECH FURNACE >100K 33.00 Permit . . . BLDG POOL PERMIT INV FEE Additional desc . Permit Fee . . . . 1189.00 Plan Check Fee 386.43 Issue Date . . . . Valuation . . . . 90000 Expiration Date 1/10/10 Qty Unit Charge Per Extension BASE FEE 829.00 40.00 ---------------------------------------------------------------------------- 9.0000 THOU BLDG 50,001-100,000 360.00 Permit . . . ELEC POOL PERMIT -RES Additional desc . Permit Fee . . . .' 45.00 Plan Check Fee 11.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/10/10 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 . . . . 45.00, Plan Check Fee 11.25 LQPERMIT a Application Number . . . . . 09-00000751 Permit . . . . PLUMBING Issue Date . . Valuation . . . . 0 Expiration Date 1/10/10 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 3.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 9.00 ------------------I---------------------------------------------------------- Special Notes and Comments POOL, 2 SPAS, 2 FOUNTAINS. ALARMS/BARRIERS SHALL BE IN PLACE AT . PRE -PLASTER INSPECTION. INVESTIGATION FEE ASSESSED PER 1997 UNIFORM ADMINISTRATIVE CODE §304.5 'FOR WORK BEGUN WITHOUT BUILDING PERMIT. ---------------------------------------------------------------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 4.00 Fee summary Charged Paid Credited --------=-------------------------------------- Due ---------- Permit Fee Total 1342.00 :00 .00 1342.00 Plan Check Total 424..68 .00 .00 424.68 Other Fee Total 4.00 .00 .00 4.00 Grand Total 1770.68 .00 .00 1770.68 LQPERMIT .� . � ? � \� » � � . � 2« d » r . �� � \� »\ : . : a « �� \� ��� \� � � \ � � / \� / } � � § \ .y � . � e� < � . � . \. \ .� . � , « � ^�� \ � \� \ a � \ �� \� y>�� :� .� \ ~ � .� \ Bin # City of La,Qutn�a Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit #` n , �� 0 Project Address: Owner's Name: Address: A. P. Number: Legal Description: City, ST, Zip: Contractor: �� Address: -3 ,J -• Telephone:�S`` ::::,:,,(Y;..<.>:.:: z<::•:: Project Description: City, ST, Zip: Q Y30114i Poo -�r�f,"�%:,:>:.,;>:< State Lic. # : s `<:.>'s;:rr. City Lie. #: EPATelephone: �S U l i�.V"C�"1 UIL 2— Arch., Arch., Engr., Designer: Address: City., ST, Zip: Telephone:.' State Lic. #:>"z Y >vvv.`:.•::, °<•^<<:: r•. � . FY;><«:.:.�;,. Construction Te: Occupancy: Project type (circle one): New Adj'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: LI oQ Q APPLICANT: DO. NOT WRITE. BELOW THIS LINE # Submittal Req'd Recd TRACMG PERMIT 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 Title 24 Calcs. I.Plans picked up Construction Flood plain plan Plans resubmitted Mechani!iai Grading plan 2"' Review, ready for corrections/issue Electrical . Subcontactor List Called Contact Person Plumbin? Grant Deed Plans picked up. S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 'd Review,.ready for corrections/issue Develop -r Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 53� 443 ss CITY OF LA QUINTA' SUB-CONTRACTPIR L121,,� - - JOB ADDRESS PERMIT NUMBER cl - 7 S L_ OWNER BUILDER . This form shall be Hosted on the job with the Building Inspection Card at all times in,a conspicuous place. Only persons appearing on this list or their employees are authorized to work 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 a stoppage of work and/or the voidance of building permit. For. each applicable trade, all information requested below must be completed by applicant. •°On File" is not an acceptable response. Trade ! Class�ficat�on Contractor S a ;:Contractor s License . ::....:...::.. ::::::;:>::::::::::: ::: < t to :.. = ' :. W.orkecs.Corrt ensatgon :�nsuran�e:' ::.::::.. ,::::: City Business Company Name Classification (e.g. Al B, C-8) License Number (xxxxxx)) Exp. Date Ixx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) EADateLicense (x Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK 1C-12) ..�NAVAAP6 0X.4 )dATIGN / Q698 76 4'36'10 Go U +t�'�NSuy�G� .i3 %� ?.3-n� � x/33 CONCRETE (C-8) FRAMING STRUCT. S'I EEL (G-51) ✓ j1rQ 1l0 - j G � p �v O en e W r% n D Z3 L it 1 � 3 MASONRY tC-291 _ PLUMBING (C-36) - =1C /� �/ p ����! �� 3v-�� C�/,�Pn �2 r,U SU AN -7 3J U Z3 D . .77:.:.:;. I:ATH.. PLASTER (C-35) DRYWALL JC -9).::. ELECT .: 9� LoRICAL.(C=10)-; .? 3//23v�10-1-09� SNEET.METAL (C43) FLOORING (G -:TSI;. GLAZING (C-17): INSULATION (9721. C-42) SEWAGE DISP (C-42)-- PAINTING (C=33) PAINTING CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) LANDSCAPING (C=27.).'-' 17-V- POOL (C-53) ZN%L3aNA-t/DNAV l7 .S.S o� D /ZMZz� .z3� o .7z8' 0