RPL (11-0169)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00000169`-:
Property Address: C'79624`MISSION DR -)E
APN: 649-6507013- - -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 28000
Applicant:
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING' & SAFETY DEPARTMENT
BUILDING PERMIT
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 ofessi nals Code, and my License is in full force and effect.
License Class: C5/3 ' nse No.: 856835 '
Dat w ntra&,: .
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 apermit subjects the applicant to a civil penalty of notmore 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 I am exempt under Sec. , BAP.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
1 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: p
LQPERMIT
Owner:
HERLIN& JOHN & KIM
79624 MISSION DRIVE
LA QUINTA, CA 92253
Contractor: I I
VACATION POOLS INC
PO BOX 10940'
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760)'777-7153
FF3 1 "r 2011
INDIO, CA 92202
(760)775-0468
Lic. No.: 856835
Date: 2/16/11
------------------------------------------------
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 numbei are:
Carrier STATE FUND Policy Number 19485484-2010
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 to.become subject to the workers' compensation laws of California,
and agree that, if I sh becyy sub' a to the workers' compensation provisions of Section
/�%• yp 3700 of the Labor , I ISall f rt i to I ith those provisioris.
iu te" v Pelican . '
WARNING: FAILURE TO SE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER T RIMINAL 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 buildi onstr i n, hereb authorize representatives
of this county to enter upon the above-mentioned prope for ins p cti n roses
ate• -S �I Si ture (Applicant or Agent):
Application Number
11-0.0000.169
Permit
BLDG POOL PERMIT
Additional desc .
Permit -Fee . . .
271.50 Plan Check Fee
176.48
Issue Date . . . .
Valuation
28000
Expiration Date
8/15/11
Qty Unit Charge
Per'
Extension
BASE FEE
252.00
3.00 6.50.00
THOU BLDG 25,001-50,000
19650
Permit . . .
MECH POOL
Additional desc .
Permit Fee . .
26.00 Plan Check Fee
6.50 -
Issue Date
Valuation
0
• Expiration Date :
8/15/11
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
8/15/11
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
8/15/11
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
.1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00.
- --------------------------------=------------------------
Special Notes and Comments
POOL/SPA, BBQ W. ELECTRICAL, GAS
LQPERMIT
Application Number 11-00000169
Special Notes and Comments
STUB -OUT FOR FUTURE USE. ALARMS/BARRIERS
SHALL BE IN PLACE AT PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED. 2010 CODES.
------------------------------------------------------------------------
,Other Fees BLDG STDS ADMIN (SB1473)
1.00 -
Fee summary Charged Paid
Credited
Due
Permit Fee Total '375.50 .00
.00
375.50
Plan Check Total 202.48 .00
.00
202.48
Other Fee Total 1.00 .00
.00
1.00
Grand Total 578.98 .00
.00
578.98
LQPERMIT
Bin #
City of La Quinta
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 # '
Project Address: kilyspA) r r��r
Owner's Name: /
'A. P. Number:
Address: w6a y /
Legal Description: ---
City, ST, Zip: G (0/�TCI C/4 a
Contractor: �L ii (j �V Joe,
Telephone: ..
Address: PO/ �' �/a
Project Description: OO G � S
/109
City, ST, Zip: Ae/�
/G 1. go 2,
Tele hone: (J�.:/ !%O
:?��'�.��• Y:f�f>:�.�4r�;��r,; ..~.<
.
State Lic. #: 3 C83Y . City"Lic.
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Yr•".,,,' ~YgS .
.�M�w�' •' N:�t
„i
.:.~.::`»':`Y>•: ^»• < k
Construction Type: Occupancy:
YP
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: �s 2C CC
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: Q '0 499
Estimated Value of Project: $ COV � �
APPLICANT: DO NOT WRITE BELOW THIS LINE
# .
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
l 6
Item Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Coles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2' Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
''' Review, ready for correctionstissue
Developer Impact Fee.
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
VACATION POOLS. INC: r
---� - 83900 Avenue 45, Suite C ; .x
>Indio, CA 92201
Install (3)' California Fan Palms Ph. (760) 775-0468, Fax(760) 775-0469
3' to 5' Trunk heights License # C-53-856835
NOTE:
+18" Raised,'7'-0" Dia..5po with Land5ca e e ements T
Concrete Cap, Stucco veneer, p . (tees, Shrubs,
• 6-0" wide boulder spillway, dual Vines and Lawn) ondl Patio Furniture
level seating and (1) Jazz light shown for illustration only.
with color wheel
Unless by `separate bid.
• PA
• - , , a
> Stub Gas Line Pool Bench
>.
for future use
> Existing NOTE:
Hedge planter PA
> ALL EXI5TIN6 DRAINAGE
to remain Pool 5HALL REMAIN INTACT.
> (20' x 32') TIE ALL NEH DRAINAGE
TO EXI5TIN6.
>
>
> Tanning Shelf
> with Umbrella
5l eeve
> Existing Hedge
planter to '
PA remain _
3'X5' Outdoor Cooking Center ,
with 50" 550, Tile Countertop,
_- ,� ,_.�_S_t000O_Exterlor Veneer Flex_
• _amp and 5tolnless'>5tcal ' '' ; • �: -r — -
> New Concrete Equipment Door.
Decking Y`
(I,Ibq sq♦. ft.) PA PAF •,
Y
Exl5ing Covered
Patio and Concrete
to remain '
Exlsing Covered
Patio and Concrete
to remain Walkway to Costio
and Front Walkway
® (425 sq,. ft.)
Existing Sound Wall
CITY OF LA Q
` BUILDING & SAFE DE
APPROVE
E
HERL I NC - Poo/sopa .
' ,RE5IDENGE -
ctuip a t. H. fORCONSTRUCTIO
<pA /5// c�
NOTE: A/C PA
Jet/Route 6a5 and Electric
under Driveway to Pool/Spa Existing sound Wall
Equipment location per plan.
(9).' E i _ DATE REVI5ED
m E r e r�g 02/12/10 0I/2l/II
m� CONTRACTOR cannot assume responsibility for
m Q C: 0 damage to curbs, sidewalks, driveways, cement NAME: HERLIN6 RE51DENCE
0 M m slabs, sewers, lawns, trees, fences, retaining
Z walls, sprinklers, wires, valves, telephone or ADDRE55: '19-624 M1551ON DR. EA5T
-L7 C - shrubs.
_ 2 p � 0 When access is made through a neighbor's
Z m X property it is understood that you, the owner, CITY: LA QUINTA, CALIFORNIA 92253
_I n > Z have that neighbor's permission and assume full
r ®-_D-I responsibility.
TRACT:. RANCHO LA QUINTA.
O v
O4tTEt OT;PHASE: 6NATU
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