10-1053 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA `QUINTA, CALIFORNIA 92253
Application Number: 10-00001053
Property Address: 81373 RUSTIC CANYON DR
APN: 764-280-999-41 -300236-
Application description: POOL - RESIDENTIAL
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 26000 ,
Applicant: Architect or Engineer:
aF�4�w
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
' UJad
ED CONTR OR'S DECLARATION
I hereby affirm under penaltyof perjury that icens der provisions of Chapter 9 (commencing with
Section 70 01 of Division 3 of the Business r sionals Code, and my License is in full force and effect.
Licensg Cl4ss: C License No.: 658996
I WNER-MILDER DECLARATION
I hereby affirm under penalty of perjury that I arrkexempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and ProfVssions 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 (5500).:
(_ 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 oroffered 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.). .
( - I 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:
LQPERAIIT
Owner:
ANDY 'ZALESKI
81373 RUSTIC CANYON
DRIVE
LA QUINTA, CA 92253
nn
Ui
Contractor:
FAMILY POOLS CONSTRUCT
P O BOX 283
rN
LA QUINTA, CA 92247
(760)564-3655
Lic. No.: 658996
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/11/10
LI"Z�
OLT 2 2010
CITY OF LA
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I-haveand -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.
_V_I have and will maintain workers' compensation insura2peas required by Section 3700 of the Labor
Code, for the performance of t e work for whi is permit is issued. My workers' compensation
insurance carrier and policy n be are:
Carrier STATE FUND Polic mber 1344032-2009
I certify that, in the performance work for which this permit is issued, I shall not employ any
person in any manner so as come subject to the workers' compensation laws of California,
and agree that, if I sh ec a subject to the workers' compensation provisions of Section
11700 of the Labor Code, hwiAcomply with those provisions.
V
WARNIN FAI RE TO SECURE WORK ' kMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT[N EMPLOYER TO CRIMINAL PENAL ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND .
DOLLARS15100,000). 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 ubject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each p at whose request and for
whose benefit work is performed under or pursuant to an mit issued as a result of this application,
the owner, and the applicant, each agrees to, and sh efend, indemnify and hold harmless the City
of La Quinta,'its officers, agents and employees any act or omission related to the work being
performed under or following issuance of t ' ermit.
2. Any permit issued as a result of this cation becomes null and void if work is not commenced
within 180 days from date of i nce of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this applica ' stat that the above information is correct. I agree to comply with all
city an county ordinances and sta'n t building construction, and hereby authorize representatives
of/this c unt toj1�\enter 'pon the above-mqtin p section purposes.bat v Signature (Appligantge 1:
Application Number
. . . 10-00001053
Permit . .
BLDG POOL PERMIT
Additional desc .
Permit Fee258.50
Plan Check Fee
168.03
Issue Date . .
Valuation . . .
. 26000
Expiration Date
4/09/11
Qty Unit Charge
Per
Extension
BASE FEE-
252.00
1.00 6.5000
THOU BLDG 25,001-50,000
6.50
Permit . . .
MECH POOL
.Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
.6.50
Issue Date
Valuation . . .
. 0
Expiration Date
4/09/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00.
1.00 11.0000
---------------------------------------
EA MECH FURNACE >100K
- ----------.-----------------------
- - -
11.00
-------------
Permit
Permit . . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
4/09/11
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
4/09/11
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. ALARMS/BARRIERS
SHALL BE IN
LQPERMIT
Application Number
. . . . .
10-00001053
-----------------------------.-----------------------------------------------
Special Notes and
Comments
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
362.50
.00
..00 0
362.50
Plan Check Total
194.03
.00
.00
194.03
Other Fee Total
.2.00
.00
.00
2.00
Grand Total
558.53
.00
.00
558.53
Bin #
Qty ®1 La QuintQ
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 #
Project Address:
wner's Name: pv
A. P. Number:
Address: s L
Legal Description:
City, ST, Zip: 2 -
Contractor -6
Contractor t
Telephone: < ':<::; ::>:'::::`.<'::>;>;:>;:; :<::::;:.'•;:>::
Address O.
Project Description: �L —
City, ST, Zip:
Telephone:•;:>:..•:;::>:'.»:':%>
State Lic. City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:;.•:<»:A;:>:>`<:>'i%
......... <` :: ::.>:;; .<.<:<..:
ti..M••"":<'.';::....:..State Lic. '.X..
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
10 N
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
I
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionsfissue
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
6'x 9' Spa
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GOLF COUP -'5f
o
Exdsfinq 15" Ga/denWdl
5fed e (5unide Sou/dei Pad
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13,x„
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Exl-fir, 6' Wall
6'
El
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Exi-4irq Patio
Poo/ s Spa
11a�d5cape by Ota -7e(5
R ZffiLESX/ HOME `F
8/373 Fustic Canyon
Trilogy Country Club
La Ouinla
Construction
POo/5 Spa5 Fountain
C7�0>5��-355
Lic, -#658990
CITY OF lea QUINTA
BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRUCTION
DAT /O -� - %� BY hQ4 -