13-0110 (RPL)P.O. BOX 1504�� .__ VOICE 760 777-7012
78-495 CALLE TAMPICO 4./ FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 2/04/13
Application Number: (13=0.0"000110 Owner
Property Address: `8178-4 RUSTIC CANYON DR DENIS GAUTHIER PFINANCERDEPT APN: 764-280-999-80 -300237- 81784 RUSTIC CANYONApplication description: POOL - RESIDENTIAL LA QUINTA, CA 92253Property Zoning: MEDIUM HIGH DENSITY RES Application valuation: 27824
Contractor:
Applicant: Architect or Engineer: DESERT OUTDOORS INC
78065 MAIN ST STE #205
LA QUINTA, CA 92253
(760)399-9600
Lic. No.: 964474
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 Clads: X27—053 License No.:- 964474
Contractor:
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).:
(_ 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.).
( ) 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:
LQPERMIT
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 NORGUARD INS Policy Number DEWC338066
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 bec��ject to the workers' compensation provisions of Section
�� $700 of the Labor C d , shad II forthwith comply with those provisions.
Date:Applicant:
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 workbeing
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 rela ' uildiag onstruction, and hereby authorize representatives
of this cou ty tq/ enter upon the above -men _ arty for inspection purposes.
Date: Z�Irj Signat ( pAefU pli — i "
Application Number . . . . 13-00000110
Permit . . . MECH POOL
Additional desc .
Permit Fee 26.00 Plan Check Fee..
00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 8/03/13
Qty 'Unit Charge Per
Extension
BASE FEE
15.00
1.00 11.0000 EA MECH FURNACE >100K
11.00
Permi t . . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 271.50 Plan Check Fee
176.48
Issue Date . . . . Valuation . . .
. 27824
Expiration Date 8/03/13
Qty Unit Charge Per
Extension
BASE FEE
252.00
3.0'0 6.5060 THOU BLDG 25,001-50,000
-----------------------------------------------------------------------------
19.50
Permit . . . PLUMBING
Additional desc . .
Permit Fee. 18.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 8/03/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS PIPE.1-4 OUTLETS
3.00
-------------------------------------.---------------------------------------
Special Notes and Comments
SPA, FIREPIT AND BLOCKWALL 4 FT. HIGH x
11 FT. LONG PER ENGINEERED DRAWING BY
FLYING BUTTRESS. 2010 CODES.
----------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid 'Credited-
Due
Permit Fee Total 315.50 .00 .00
315.50
Plan Check Total 176.48 .00 Ob
'176.48
Other Fee Total 1.00 .00 .00
1.00
Grand Total 492.98 .00' .00
492.98
LQPERMIT
slrt.#
CIty O %.c7 QUinta
BLdlding a Safety Division
P.O. Box 1504,78-495 Calle Tampico
14.QLdnta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Addmss: 'a TUSM C C N
Owncr's Name:.1_�Nff
A. P. Number:
Address: S -% 8 C C404
Legal Description:
Contractor. Desert Outdoors
City, ST. Zip: LA Qv%VtrCt . �22
1-elephonelko .
Adm: 78-065 Main St. Ste. 205
Project Description:
city, ST, zip: La Quinta, Ca. 92253
07 SL=C4e WAtL
Telephone: 760-399-9600 a '"
1' Lp�.l �' 1 -
state Lia # : --c-53 964474 City Lic. #;
Arch., Ensr•, Designer: Flying Buttress
Address: - 77725, Enfield Ln., Ste. 130
City, ST, zip: Palm Desert, CA. 92211
Telephone: 760-772-4411
State Lia #: 33446'p n
. ` -....... ..
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo •
Sq. FL: # Stories: # Unitp:
Telephone # of Contact Person -1 w • ;—Z-) is -2-1'59
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
- PERMIT FEES -
Plan Sets
Plan Check submitted
Item Amount
Structural Coles.
Reviewed, ready for corrections
Plan ChecldDeposit, .
Truss Cala.
Called Contact Person
Pian Chech Balance,
Tide 24 Cales.
Plans picked up
Construction
Flood glair plan
Pians resubmitted.'.
Mechanical
Grading plan
2•' Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN iiOUSE:-
1id Review; ready for correetionsrissae
Developer:Impaet Fee
Planning Approval.
Called Contact Person
A.U.P.
Pub. Wks. Appr -
Date of permit issue
School Fees
Total Permit Fees