12-0762 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
IZ12-00000762
53866 ROSS AVE
767-200-998-41 -330761-
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
45000
c&ty/ 4 4
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
a(A
------------------
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 Class: C27-053 LicenseNo.: 635896
/ate.-rlontractor:
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 of 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).:
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 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 (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
IV
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/10/12
Owner:
ALAN AUSTIN TRUST (D 4
53866 ROSS AVENUE fj
LA QUINTA, CA 92253 1
JULi. 7 2012
Contractor: CI F Nq y � Q(IINTq
DUNN'S DESERT LANDSCAPE SR C- FpgpT
74866 LENNON PL, STE A - t�
PALM DESERT, CA 92260
(7'60) 773-9923
LiC. No.: 635896
-------------------------------=---------_------
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.
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
insurance carrier and policy number are:
Carrier BENCHMARK INS Policy Number CST5001717
_ 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 ecome subject to the workers' compensation provisions of Section
3700 oft Labor Cod I hall forthwith comply with those provisions.
Date: s • l � PlicanT
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 ($100,0001. 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 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. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
,df this county to enter upon the above-mentioned property f(/o/f/.inspection purposes.
Dater.- r, 1 lure (Applicant or Agentl:
Application Number . . . . . 12-00000762
Permit . . . .BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 382.00 Plan Check Fee 248.30
Issue Date . . . . Valuation . . . . 45000
Expiration Date . 1/06/13
Qty Unit Charge Per Extension
BASE FEE 252.00
20.00 6.5000 THOU BLDG 25,001-50,000 •130.00
----------------------------------------------------------=-----------------
Permit . . . MECH POOL
Additional desc . .
Permit Fee 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 1/06/13
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 1/06/13
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 1/06/13
Qty Unit Charge Per Extension
BASE FEE 15.00
2.00 6.0000 EA PLB FIXTURE t 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 3.00
--------------------------------------------------------------------------
=-
Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
LQPERA1IT
Application Number . . . . . 12-00000762
----------------------------------------------------------------------------
Special Notes and
Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
2010
CODES.
----------------------------------------------------------------------------
Other Fees
. . . . . . BLDG STDS ADMIN (SB1473)
2.00
Fee summary
- - - - - - -•
Charged
---- - - - - ----
Paid
-- -- - - --
Credited
---- - - - - ----
Due
-- - - - - - -
- ------=--
Permit Fee Total
486.00
.00
.00
486.00
Plan Check Total
274.30
.00
.00
174.30
Other Fee Total
2.00
.00
.00.
'2.00
Grand Total
762.30
.00
.00
762.30
LQPERMIT
City Of La Quints
RWdmg 8r Safety Mof6n
P-4 Box 1.504,78-495 OR Tampfw
4.Qtrtmk CA 92253 -:(760) 777-7012
' fg Pern�it
Burl Application" and Tracking Sheet
Pem* 8
Project Address: Lex o —fit ( SAug "
Owner's Namur . •
�s
A R Numbed 3.8�90,55 AVIS:'
Add,,,. yo—Ill 05 GG-
Legal Dcsmipfiow
Co�ador.
.Agn
Com. ST. gip: S
Tekphonc:
Addmw- -7 L e n o in
PmjedDc on: p
City, ST, Zip- renr' — r C $ O
Telcpho=760- 7S'- f'6
state LiQ # : 6 t b tom► Lie.
AMb, EW., DmptrT
A �ut Al
Cay, sr,'Alm
- -
T = 7*0 s 7 — qlf %
State Lim #: 19
Name of Contest Petmm
slfuction Type; .Q Oocupaney:
c:d type (eucle one): New AM'n Alta Reps Demo
!F4.,mm
# Sto:isrdcphoac
# of Caatact Pet�mi
aDod value of Project
APPi=W, DO NOT WWFE SAW THIS LINE
#
'
submittalgtgd
Elan sets
eee'a .
18ACKW6
Ehn C9mek sabmithd
P>;RRHf FRFs
Item Amohhnt
Strq Cala.
Revk%,A relay for co;recdons
Phu a+oric Deposit. .
Thnss Cala.
Caped Coofaet person
Phn C'hcek Sa�anee
IMt 24 Cates.
Eh® Pied up
Cunaft ction
raw Aft &a
P reshhbmithd..
Metbahiieai
GhdinS &n
Z Review, remv for conwiaas lure
mec ieal
Snbcostaetor List
CaIIed Contact Person
Plumbing
C4ant Decd
Phos plelmd up
H.U.A. Approval
P9aas rQadft
III HOUSS:-
'"` ite.,MW9 zzady for onslissae
Devrloper Impaet Fee
nSAPP 1
cagedcovftdPasan
A.LP.Y.
Pub- Wits. Appy '
Date of permit ime
School Fees
Total Permit Fees