12-0619 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
. -...N. _
trA--ppllcati�onumber:--' 12_-_00000619
Property Address:- .52520 AVENIDA RAMIREZ
APN: 773-292-002-22 -000000
Application. description: POOL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL.
t Application, valuation: '18000
. �Ti&t 4 XP,Q"
Applicant: Architect or Engineer
BUILDING &SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
PINSON
52520 AVENIDA RAMIREZ
LA QUINTA, CA 92253
D
JUN 0" 2012
WY:OF IA QUINTA
FIND. iCE REPT.
LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm under penalty of per'_rl.u,,ry that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of CtBusiness and Profes ionals Code, and my License is in full force and effect.
License Class: C53 License No.: 841981
Date:rContrr to
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).:
(_) 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.l.
(_ I 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 contractors) licensed
pursuant to the Contractors' State License Law.). • .
(_) I em 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
Contractor:
A & R COMPLETE POOL SERVICE
P.O. BOX 103
LA QUINTA, CA 92247
(760)272-7349
Lic. No -.:•841981
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/05/12
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 SOUTHERN INS CO Policy Number PWC000373-11
_ 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 th t, if I shou become subject to he wor s' compensation provisions of Section
3700 of th ab\r Co ; I shall fort with c ply w' those provisions.
Date:.(G"S' 1 Z "App c
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 1
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 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 i formation is c act. I agree to comply with all
city and county ordinances and state laws relating to wilding c s ruction, an reby authorize representatives
of this county to enter upon the above-mentionedto
party for ection pur es.
Date:'16L: �ignature (Applicant or Age-
LQPERMIT
Application Number . 12-00000619
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . . 189.00, Plan Check -Fee
122.85
Issue Date Valuation
18000
Expiration Date 12/02/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
16.00 9.0000 THOU BLDG 2,001-25,000
144'.00
Permit . . . MECH POOL
Additional desc .
Permit Fee 26.00 Plan Check
Fee
6.50
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 12/02/12
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 12/02/12
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 12/02/12
Qty Unit Charge PerExtension
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 12-00000619
------------------------------------------ ---------------------------------
Special Notes' and Comments
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 293.00 .00
:00
293.00
Plan Check Total 148.85 .00
.00
148.85
Other Fee Total 1.00 .00
.00
1.00
Grand Total 442.85 .00
.00
442.85'
r
LQPERMIT
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QtY Of La Qullltd
BulkUng 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La.Whta, CA 92253 -:(760) 777-7012
Building Permit -Application' and Tracking Sheet
Permit #
10
Project Address: a 5a1Untela r4g
Owner's Name:. Y-.IS b n)
A. P. Number.
Address: 5a 5ab Avgn tda, i r' z-
Legal Description:
Contractor. J
City, ST, Zip: U/L2i l t7 C2t - rJ�
Telephone: r"
Address: 6 6O
Project Description: Z
City, ST, Zip: IA- d LL/ n`7 7 /
i D D 4- �7 1 Cl �a I
Telephone: `l69 -a 7a -73g9= . r Ri c ..
State Lia # : City Lie'. #;
l I )-11/)
Arch, Engr., Designer
Address:
City., ST. Zip:
Telephone:
State Lia #: .<..
Construction Type:. Occupancy:
Project type (circle one): ew Add'n Alter Repair Demo
Sq. FL: # Stories: # Univ:.
Name of Contact Person: ROY V l dWiz✓
Telephone # of Contact Person: Q •. 7a ;7 3
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE.
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES-
Plan Stu
Plan Check submitted
it '
Amount
Structural Cafes
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contac Person
Plan Check Balascs.
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Pians resubmitted
Mechanlcal
Giading plan
Z`! Review, ready for correctionsfssue
Electrical
Subeontador List
Called Contact Person
Plumbing
Graut Deed
Pians picked up
ML
H.O.A. Approval
Plans resubmitted
Grading
Its iI0USE:-
''a Review; ready for correctionsAssue
Developer Impale t Fee
Planning Approval
Called Contact Person
Ad.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees