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13-0004 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13=X00000004 Property Address: 81817"RUSTIC CANYON DR APN: 764-280-999-46 -300237- Application description: POOL - RESIDENTIAL Property Zoning: MEDIUM HIGH DENSITY RES Application valuation; 26000 T,iht 4 414�Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: VERBEEK 81817 RUSTIC LA QUINTA, CA CANYON DRJ17L' 92253 Contractor: Applicant: Architect or Engineer: TESERRA P.O. BOX 1280 COACHELLA, CA 92236 (760)398-9222 PI A Lic. No.: 656128 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that Ilicensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business a Professionals Code, and my License is in full force and effect. /LLiicense Cla , 10 , 27 , 2 License No.: 656128 Z!.` Dater �Z Contractor: All /// 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 Cade) 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 _ 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 contractorls) licensed pursuant to the Contractors' State License Law.). I—) I am exempt under Sec. , BAP.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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/04/13 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 requir6d 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 EVEREST NATL IN Policy Number 7600006481131 _ I certify that, in the Performa . a 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 shout ecome subject to the workers' compensation provisions of Section ��of the Labor Cod hall forthwith comply with those provisions. .. Dater 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 (5100,000). 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 abov nformation is correct. 1 agree to comply with all city and county ordin ices and state -laws relating to building c struction, and hereby authorize representatives , this count e r upon the above-mentioned property f pection purposes.. Date: ignature (Applicant or Agent): LQPERMIT Application Number . . . . . 13-00000004 Permit . . . BLDG POOL PERMIT Additional desc . Permit Fee . . . . 258.50 Plan Check Fee 168.03 Issue Date . . . . Valuation . . . . 26,000 Expiration Date 7/03/13 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 7/03/13 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 7/03/13 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 7/03/13 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 Permit . . . . . WALL/FENCE PERMIT LQPERMIT Application Number 13-00000004 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee 15.00 Plan Check Fee .00 Issue Date Valuation 128 Expiration Date 7/03/13 Qty Unit Charge Per Extension BASE FEE 15.00 - --------------------------------- Special Notes and Comments POOL/SPA. INCLUDES 120 L -F. 1 1/2" GAS " LINE & 8 L.F. 4' EQUIPMENT ENCLOSURE, CITY STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. PERMIT DOES NOT INCLUDE RELOCATION OF MECHANICAL/HVAC EQUIPMENT. 2010 CODES. -------------------------------------------------------- ------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN ,(SB1473) 2.00 Fee summaryCharged Paid Credited Due i---- --------------------------- Permit Fee Total 377.50 .00 .00 377.50 Plan Check Total 194.03 00 .00 194.03 Other Fee Total 2.00 .00 .00 2.00 Grand Total 573.53 .00� .00 573.53 Bfn.# Permit # , ,1, !.� Project Address: City. Of LA Qutnta Bulkog 8L Safety Division P.O. Box 1504,78-495 Cafte Tampico . La.Quinta, CA 92253 -:(760) 777-7012 Building Permit •Applicadon and Tracking Sheat S �p Owner's Name:. G �� A. P. Number. Address: Legal Description: City, ST, Zip:LA � u� Contractor Telephone: s ; Address: c96 ADO Project Description:. city, sr, Zip:(fKO, Z23 ,L Y o % �� d ��.✓E Telephone: v9C, 2 Z� Q Cw State Lie. #: Asch., Engr., Designer: 2 City Lic. #; Address: City, ST, Zip: Telephone: State Lie. #: Construction Type:. Occupancy: Project type (circle 0(, -): New Add'n F1ter Repair Demo Name of Contact Person: AAA Sq. Ft.: # Stories: # Unit; Telephone # of Contact Person: 0 210 2 l Estimated. Value of Project: Z d 0 O # Submittal APPLICANT: DO NOT WRITE BELOW THIS UNE Req'd Reed TRACMG PSRMfr FEES Plan Sets Plan Check submitted Item Amount Structural Calfa. Reviewed, ready for corrections Plan Check Deposit. . Truss Cates. CaUed Contact Person Pian Check Balance, 1Mde 24 CalcL Pians picked up Construction Flood plain plan Plans resubmitted:. Mecharilcsl Giadlag plan 2' Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. Ii.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3" Review; ready for correctionsPissuc Developer Imps.ct Fee Planning Approval Called Contact Person Pub. Wks. Appr 1 Date of permit issue School Fees Total Permit Fres -1 � i t O, D c t� �' R.B.B. SEE STEEL r // s ,: C: i i I I� { CI f - , I r _ 11 11 < MMIA - IA - -1 11I1 ' NTRYPA NCHE - -, OWNER . 'N E R R E SPONSIBILI T1 ES OWNER TO: 1 DETERMINE THE APPROXIMATE ELEVATION OF P O O L OR S PA AT LAYOUT ON DAY F EXCAVATION.A VATI ON. 2 TAKE NOTICE THAT POOL AND EQUIPMENT LOCATIONS ARESUBJECT TO ACCEPTANCE OF 11512 N 58Z,LOCAL BUILDING DEPARTMENT AT THE TIME F ISSUANCE OF PERMIT:� .ENTRY 'WET DOWN CONCRETE SHELL AT LEAST TWICE DAILY FOR SEVEN DAYS AFTER SHELL IS INSTALLED.(3)- 11 4 AGREE THAT TESE RRA IS NOT RESPONSIBLE FOR UNDERGROUND CONDITIONS OR OBJECTS,AND AN DAMAGE TOCURBS, SIDEWALKS DRIVEWAYS LAWNS OR OTHER ITEMS IN THE ACCESS AREA.