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04-6442 (RPL)P.O. BOX 1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT Application Number - Property Address . . . . APN: Application description Property Zoning . . . . . Application valuation . . Owner- ------------------------- DAVID ORTIZ 57880 BLACK DIAMOND LA QUINTA CA 92253 BUILDING & SAFETY DEPARTMENT (760) .777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 04-00006442 Date 57880 BLACK,DIAMOND 762=370-023 - - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 35000 Contractor 9/24/04 DEVINE SWIMMING POOL DESIGN 80844 BOULDER DRIVE INDIO CA 92201 (760) 989-0354 WCC: STATE FUND WC: 1641733 07/01/05 CSLB: 786814 11/30/04 CCC: C53 ---------------------------------------------------------------------------- Permit . . . . . . MECH POOL Additional desc Permit Fee 24.00 Plan Check Fee 6.00 Issue Date . . . . .Valuation . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000_.EA MECH FURNACE <=100K 9.00 ---------------------------------------------------------------------------- Permit. . . . . . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 317.00 Plan Check Fee 206.05 Issue Date Valuation . . . . .35.000 Qty Unit Charge Per BASE F 10.00 6.5000 THOU BLDG 2 ----- ---------------------------------- Permit ELEC POOL PER ff Additional desc Permit Fee . . . . 45.00 Issue Date . . . . Qty Unit Charge Per BASE FEE Extension 252.00 =LA 65.00 ------------------ CI�r OF QUINT11.25 t", h- ch, k Fee ` uaticn . . . . 0 Extension 15.00 P.O. Box 1504 i�� / VOICE (760) 777-701: 78-495 CALLE TAMPICO Tihf 4 4 FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number:--ce I V(/ a --I Date: Applicant: Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's ddress: Lic. No.: BUILDING PERMIT DECLARATIONS 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 Class c^T� 1 License No. I 0 Date " Z ' c)l Contractor l�e�� —� P6 0 s SPAX OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U 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 or 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.). U 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.). U I am exempt under Sec. . BA P.C. for this reason Date WORKERS' 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 ar�d polis number are: Carrier �-i-4 i -e, -err. of Policy Number / (oil �7 5 -S _ 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 become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall �i forthwith comply with those provisions. Date Applicant_ WARNING: \Q�� 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. 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 Lenders Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restriefions 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 Ouinta, 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 dale of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that 1 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 relating to building construction, and hereby authorize representatives of this county to enter upon the above --me oned property for inspection purposes. Date O�— 1-7-1514 Signature (Applicant or Agent): Page 2 Application Number . . . . . 04-00006442 Date 9/24/04 Qty Unit Charge Per Extension 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 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 PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged Paid Credited Due Permit Fee Total 419.00 .00 .00 419.00 Plan Check Total 231.55 .00 .00 231.55 Grand Total 650.55 .00 .00 650.55 V7I r fl u�1.�Dkl< VlF(-Ki VJf-i F R lk,ine Ftlela and SAWS ( `- 53 71e(,8I4 H W ( (bo) 9MC)43.54 M PROPOSAL c 001� ,iI E k TOf"' I I%T4A . A L -' ALAI 1LE,4ER We Lrcreby suhmii specificWioAS and CSILKIate for ConstnxUja Of uerti• gufjitc swimnunb pool and stwhad sixi Pool to he 7 sluil?a Per plan. appraxirnaicly f"t squaw feet of surfaw-rm-ea. a' X 12' usnaing shelf for top SLOP at entry 3' tc 5' depth of raisad bond beam at 30'. 2- 1' c=u3t L cascadi:.s centet in back beam of pool uri each side between spa and end of pool. Attaehrd spa to be 7' square with G jets and to [cvci seat. 5' wide stacked quasuite sptllwav into pctiol. Spa at + 30'. Gaup one waterlm-_ We io'be sckx-ted. Pebble itnLsh oolor to be sclWed. Apprommaidy 23M) square feet of br OM ftesished. colored concrete µrr plan_ Poo] deck on em h side of pbo3 I 3 slips quaff +2=' elevation. 6" exposed area on back, owudc beam i3f pool and spa to be quartrttc: 12' high Ltrc pit per ptanand eHulas t timsh an kite outsi& Loslde hood with lire brLck and filled with silica sand and 3"-S' lava rork. L3 !lm c for{ut BBQ: o�z& ated vac line for future auto c1c4=1. Equipincm aA foliows: I - GoldhiT PS 8 Aqualogic wiA1`aper wl mtcgrdI sale chic nne gc:tcfator. I- Wltisperflo 2hp circJ jd pttmp I- Whtsperflo llip jet boasrter PurrLp l- Whisperflo 2bp watcrfalt pump l- C'lcan arLd Clear 32(} squaw foot carindga Ctltef 1-Mintmax #tlt),I}tlil BTU heater 1- standard pr-all light artd 2 mall lights in pool 1- siarkidrd spa light 2- Wat crway-t st rbu skirn=rs 1- Md Lndus ties auto fill; dcvloc Wattti s) AM valve 9��ioy 6y�