05-2504 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
05-00002504
X78625 BOTTLE BRUSH DR,
646-312-012-62 -000000-
POOL - RESIDENTIAL
MEDIUM DENSITY RES
16000
Td4t 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
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: G a License No.: D T (. V
Date: !!� Contractor: �,� r�ZO (� W r�.�� r 4r
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 155001.:
(_) 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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_ I 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
FINANCE
BOX 134
INTA, CA 92247
:tor:
O POOLS &
EXEMPT
WC: EXEMPT
CSLB: 836900
SPAS
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
05/31/06
04/30/06
Date: 6/21/05
%w•
WORKER'S COMPENSATION DECLARATION
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 C53 Policy Number - - - - - - - - - - - - - --
_ 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, I shall forthwith
comply with those provisions.
Date: Applicant: 121
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 ($100,0001. 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, 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 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-mentioned property for inspection purposes.
Dated&Signature (Applicant or Agent):
a
Application Number . . . . . 05-00002504
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 171.00 Plan Check Fee 111.15
Issue.Date Valuation . . . . 16000
Expiration Date 12/18/05
Qty Unit Charge Per Extension
BASE FEE 45.00
14.00 9.0000 THOU BLDG 2,001-25,000 126.00
----------------------------------------------------------------------------
Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
26.00 Plan Check Fee . . 6.50
Valuation . . . . 0
12/18/05
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 12/18/05
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ..ELEC PRIVATE SWIMMING POOL 30.00
------------------ ---------------------------------------------------------
Permit . .
Additional desc . ..
Permit Fee . . . .
Issue Date . . . .
Expiration Date . -
PLUMBING
33.00
12/18/05
Plan Check Fee 8.25
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 ONLY. ALARMS/BARRIERS
SHALL
LQPERM1T
Application Number . . . . . 05-00002504
Special Notes and Comments
BE IN PLACE'PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid Credited Due
----------------- ----- - ---- ---------- ---------- ----------
Permit Fee Total 275.00 .00 .00 275.00
Plan Check Total 137.15 .00 .00 137.15
Grand Total 412.15 .00 .00 412.15
LQPERAIIT
LA I Y OF' -LA QUINTA UB CONTRACTOR LIST
JOB ADDRESS 18 �ZS�o-rti-� �Z�srJ�2. PERMIT NUMBER 05--2� OWN i: BUILDERT-6CA?-t-> QS--TQAA.��&-�
This form shall be posted on the iob with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Fab ly a to comply will result in a stoppage of work and/or the voidance
of building permit. For each aDDlicable trade. all information reauested helnw m. mt ho nncnnlatarl by nnnlicant t "(ln Pilo" is not nn nr•rrantahla rccnr% c�-
Trade / Classification
Contractor
State Contractor's License
1Wrker�s Coompensatiori Insurance
City Business License
Company Name
Classification.
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xxlxx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp.*Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
�taAzo 4�jQtiloAk-?ccL,S
G'53
Oa
30
CONCRETE (C-8)
FRAMING (C-5) '
STRUCT. STEEL (C-51)
lG Ga3S S
C• 3'
OG
MASONRY (C-29)
PLUMBING (C-36)
i1�14zo o ®!�
�' •$
O� e}O®
'�•Q•
LATH, PLASTER (C-3
a F.S FA.l.,t1
•3
.3®•�
F,µ•PLcY gb �"'�'
DRYWALL (C-9)
HVAC (C-20)
ELECTRICAL (C-10)
�4.'�.c(�c� L,rj
, $
of�
•3F9•
I �L
ROOFING (C-39)
SHEET METAL (C-43)
FLOORING (C-15)
GLAZING (C-17)•
INSULATION (C-2)
SEWAGE DISp. (C-42)
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13).
LANDSCAPING (C-27)
POOL (C-53)
�I i��. A'� t i.S
®
�a.�
" &0'S A-rIl FudDi 'SSE
-0e l la+o5
c
EX CT:07LOc.K WALL
CITY OF LA QUINTA
BUILDING $ SAFETY DEPT.
APPROVES !
FOR CONSTRUCTION
r c
DATE `l 2116 Ay GS
SWIMMING POOH, SPECIFICATIONS
POOL SPECIFICATIONS
type: L dit ME size: X
surface area: perimeter. O = O
depths: min .T' 0 max. ^ O
SPA SPECIFICATIONS
size:5!_X�1�►�surfacearea rimeterme
dam wall width: length:=spa rai ed: -a• 2
spillway type: 1 L # of jets:
notes:
EXCAVATION/STEEL
type of dig. $eGea-C access: 0M
elevation: D
wall/fence removed by:
wall/fence
conc.removal: sod removal:
tree/stump removal: -_.
6"r.b.b. -r 12"r.b.b.__18"r.b.b.'�-
surcharge: %if -5 bench/loveseat:
tanning shelf water depth:
GUNITE
6"r.b.b. 12"r.b.b49'91 18"r.b.b.
bench/loveseat: — extended god step:
spa dam wall width:
spillway type: t..
DECKING
SQ.FT.13%**l 17rAF-2e, finish:.
color
cantilever expansion joints:
steps: type:
deck drains: decco-drain:
curb core: sand&visqueen:
,TILE & MASONRY
coping type:
spillway type: £
6"r.b.b. -- 12"r.b.b.. -039t 18"r.b.b.
r.b.b. facing: Tii _ 4=trim tile:
file type:
equipment wall: X type:
PLUMBIING & ELECTRICAL
plumbing size: V1 fill line:
skimmer type: F #
gas line: Y4.4 electline: Vt
beater- y(f t • AtAti[ size: omel
filter(d Aw) s Gl.>td fr, size: 320 45 CA
pool pump:tal{IISPeC FL.c size:I-SUP
jet pump: — size:
sub -panel: time clock.
GFIC.=: PAy 1? extra GFIC.
pool light: YtiS spa light:
gas stubs: electstubs:
plaster color
pebble: color:
NAME: l
Job address:1a•tp25 F)r0y .1EzRtlS
City: 'L
scale: ! �11= I = 0 date: ZO