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12-0846 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: X12 = 0.00_QO-84C—'n Property Address: 53280 AVENIDA RUBIO APN: 774-073-002-23 -000000- Application description: POOL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 42000 Applicant: Tuvl 44" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: Owner: LUCY SHREFFLER 53280 AVENID RUBI LA QUINTA, CA 922 Contractor: UNITED STATES PO LS C 41905 BOARDWALK STE PALM DESERT, CA 92211 (760)674-9700 Lic. No.: 891048 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/31/12 AUG o 3 2a�2 �+ CITY OF LA QUINTA ------------------------------------------------ ' LICENSED CONTRACTOR'S DECLARATION -- ----------------------------------------------— .WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided Licensellasi C8 C10 C53 License No.: 891048 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is /Date: 3 `--' Contractor: h 1 �� FJ1 �I�t � Q l (ro - issued. - /�I have and will maintain workers' compensation insurance, as required by Section 3700 ofthe Labor i Code, for the performance of the work for which this permit is issued. My workers' compensation OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier NATIONAL UNION Policy Number 910606 following reason (Sec, 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to -its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or for Any Section 7031.5 by 3700 of the Labor Code, I shall forthwith comply th those provisions. / that he or she is exempt therefrom and the basis the alleged exemption. violation of 1 � `) _ �1, � I� U)% f (/ any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: pplicant: J7T (_ 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. , 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: A Lender's Address: LQPERMIT 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 0100,0001. 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, indemnity 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 a ee ZIP comply with all aty d county ordinances and state laws relating to building const' ion, and hereby au oriz representatives of is c uty to enter upon the above-mentioned pro y for inspe ion purposes Date: 3 1 ?,,/nature (Applicant or Agenl LQPERMIT Application Number . . . . . 12-00000846 Permit BLDG POOL PERMIT Additional desc . Permit Fee . . . . 362.50 Plan Check Fee 235:63 Issue Date Valuation 42000 Expiration Date 1/27/13 Qty Unit Charge Per Extension BASE FEE 252.00 17.00 6.5000 -------------------------- THOU BLDG 25,001-50,000 -------------------------------------------------- 110.50 Permit MECH POOL Additional desc . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date . . . Valuation 0. Expiration Date 1/27/13 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 1/27/13 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 •1/27/13 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 . . . . . 12-00000846 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation 115 Expiration Date 1/27/13 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments POOL/SPA,' 15 L.F. 4' WOODEN EQUIPMENT ENCLOSURE. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. 2010 CODES. . Fee summary Charged Paid Credited Due Permit Fee Total 481.50 .00. .00 481.50 Plan Check Total 261.63 .00 ..00 261.63 Grand Total 743.13 ..00 .00 743.13 LQPERMIT' . . # city..Of La Quintd Building a Safety Division Perinit # P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253--:(760) 777-7012 �2 Building Permit Application and Tracking Sheet Project Address: 90 /fve.,,dq Owner's Name:. L kC m r A. P. Number. Address: Legal Description: City, ST, Zip: �^ f r �_ Contractor. v/ G[- J7'FJO �D15 Telephone: Address:rt�wOk Star 41.3;N Project Description: Alec-) p. l S City, ST, Zip: qA1 G/ ti En YL t t/tX7� v� Telephone: 7(CO6 %Yf %OQ . Viz Q�:U% Hca State Lic. # : Arch., Engr., Designer. City Lia #: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: `�.' a �w r er- Construction Type:.. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.:#Stories: ts Telephone # of Contact Person: %/ /-/.;?,3 '7,9,7?Estimated ,,Uni //# Value of Project: y�. �BV APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKDVC PERMfP FEES PIM Sets Plan Check submitted Item Amount Strgctund Cates. Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechariltal Grading plan 2'' Review, ready for correcfionstissue Electrical Subeoutactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d Review; ready for corrections/issue Developer impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr ' Date of permit Issue School Fees Total Permit Fees CITY OF LA QUII,JTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE i (1/ BY, MR ,JUL. 3 12012 Designer: United States Pools Corp. Address: 41905 Boardwalk Suites P&O City: Palm Desert d State17ip: California 92211 Phone: 760-674-9700 Cell: 760-578-9848 Email: Michael@poolspaamerica.com Alternate Contact: Don@poolspaamerica.com License #: 891048 U i Ll - 0 0 0 LL LO 0 C J i 0 0- 0 i a_ i Property Line 5Ft Wooden Fence Length: 23 Ft Width: 19 Ft Depth: 3.5 - 5 - 3.5 Perimeter: 76 Square Footage:333 Capacity: 10,000 Material: Gunite Water Features:2 - 18" Sheer Decents Length: 7 Ft Width: 7 Ft Depth: 3.5 Ft Perimeter: 28 Lin. Ft. Square Footage:49 SgFt. Capacity: 1286 Gallons Material: Gunite Water Features: 5 Ft. Tile Spillway Filter Pump: Hayward VS Pump Filter Type: Hayward 330 Sq.Ft. Cartridge Spa Pump: Same (� Other Pumps: None C: I� Heater: Hayward H250 FDP 250K BTU Sanitation: Hayward Salt System Pool Sweep: None Other Equipment: Hayward Controller 0 0 0 LL L0 0 C J >+ i Q1 Q- 0 0 i IL