04-3895 (RPL)BUILDING & SAFETY DEPARTMENT
O. Box 1504 (760),777-7012
495 CALLE TAMPICO FAX (760) 777-7011
QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
Number . .
ress . . .
APN :
Application description
Property Zoning
Application valuation .
BUILDING PERMIT
. . . 04-00,003895 Date 5/05/04
. . . 79420 CANTERBURY
775-032-009-
. . . POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
13000
Owner
.Contractor
KOZUH MATTHEW G
CALIFORNIA POOLS & SPAS
79420 CANTERBURY.
P.O. BOX 1280
LA. QUINTA
CA 92253
'COACHELLA CA
92236•
(760) 398-9222
WCC: STATE FUND
WC: 04600061168
01/01/05
CSLB: 656128
10/31/04
CCC: C8 -C27 -C29-053
----------------------------------------------------------------------------
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
144.00
Plan Check Fee
93.60
Issue Date . . . .
Valuation
13000
Qty Unit Charge
Per.
Extension
BASE
FEE
45.00
11.00 9.0000
THOU BLDG
2,001-25,000
99..00
Permit . . . . . .
ELEC POOL PERMIT -RES
Additional desc
Permit Fee
45.00
Plan Check Fee ..
11.25
Issue Date
Valuation . . . .
0
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 30.0000
EA ELEC
PRIVATE SWIMMING POOL
30.00
P.O. BOX 1504�� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 7 5
Applicant:
Applicant's Mailing Address:
Date:
Architect or
Architect or Elhoihee(fs Address:
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, andmr - Li
y Ucenssggis in full force and effect. `' �� �2
Ucense Cl M - 53 cense No. 6
13
Date J I 1 q Contractor \
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 fife 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 worts, 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 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sea 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.).
U 1 am exempt under Sec. , BA PA. for this reason
Date - Owner.
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 self4nsure 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.
yI 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
i�sueQ. My worjwrs' compensation. insurance carrier and policy�ymber are:
Cartier 4-f-Q-f'P a-tAA� Policy Number 0 5/(0/9//lo B
_ 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 provi ns.
Data `� / Applicant
—i&tek
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.).
Lendees Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a perdu 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 penia
2. Any permit issued as a result of this application becomes null and void [two* 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 inforu4n 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 countyto ter upon ft above -mention property for inspection purposes.
Date i " Signature (Applicant or Agent):
Page 2
Application
Number . . . . .
04-00003895
Date 5/05/04
-----------------------7-----------=----------------------------------------
Permit . .
. . . . PLUMBING
Additional desc
Permit Fee
. . . . 27.00
Plan Check Fee
6.75
Issue Date
. . . .
Valuation . .
. . 0
Qty Unit
Charge Per
Extension
BASE
FEE
15.00
1.00
6.0000 EA. PLB
FIXTURE
6.00
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
SPA ONLY. ALARMS BARRIERS SHALL
BE IN
PLACE PRIOR
TO PREPLASTER INSPECTION.
Fee summary
-----------------
Charged
----------
Paid Credited
---------------------
Due
Permit Fee
Total 240.00
.00 .00
----------
240.00
Plan Check
Total 117.60
.00 .00
117.60
Grand Total
357.60
.00 ..00
357.60
12 04 09259a N;Rt` kCr
05,22/2004 IG i3 ' 7607746145
Pdiay l2, 2004
Mi. & Mrs. Matt Kozuh
79-420 Caritebury
La Quinta, CA 922.53
Dear Mr. & ibirs- Kozuh:
PGA -WEST PAAE 0'1 i el
The Architectural Committee bas aeviewed and appr®ved your request to install a spa and
concrete decking at your 79-420 Cantebury residenee,
We reserve the right to make a final inspection of this change to make sure IIIA it
matches the onSinal request. lett appaoval is bid oily on the aesthetics of your
proposed plan and should not be tatter* as .any ceitification as to the construction
:worthiness or structural integrity of the proposed change.
We want to reiterate that the maintmace of the spa and conemle decking being installed
is solely the responsibility of the homeowner and will not be the responsibility of the
Association. Tliis provision is mcorded with. the County of Riverside and runs with the
land.
We appreciate your cooperation in submitting this request for approval. If you have any
questions, please contact me at (760) 771-1234, ext. 15.
Sincerely,
felly ,cc
alliard
Operations Manager,
I the Architectural CosmY;ittee
cc* Architectural Caiamittee
54320 Southern Hills, La Quinta, California 92253-5665, Telephone 760771=1234 FAX 760-771-3.125
.5PECIFI.CATiON-S
SIZE-
SURFA0E AREA OF PNX
PERIMETER f)P'TH8 VK VAX.
-SPA 5PECIFIGATIONS.-': TILE'
SPA VAM WALL O ER IJ4
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SPIZOAL NOTES
EXCAVATION ./
STEEL.
TYPE
ACCESS FROM
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PWAEFE REYOVAt
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IRRIGATION. . REMOVAL AX CAn
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ir
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SPILLWAY TYPL____L�
CA'HTILEIW
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DECKING
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DECK DRAINS''
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MOW_STFqP-
MASONRY
C!Dplw TYPE
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lf, s3zi
PROP. EXT.- WALLS
EAUP, WALLS
FIREFIT "
u[;r175_ PCB
UGHTS SPA
Rcurw gow
DEHI?1P SPA
f)E5ALL!S
FENCE ri?E
GATE'PMRSAL
RFWVt & G
PAT_START
RIM t0fAFPLEnlaR
OTHER
OWNER TO: (l) OVERWNE THE AP1'Rb6ATE ELEVA-RCN OF POOL OR SPA AT-LAYdA ON 0AY'0F EXUVAV6�
(2) TAKE NOTLQE THAi-PPUL ANIT EWIP4AENt LWA-RDNS ARE 5U . MT TO . ACCEPTANCE 0 . F ..
LOCAL au joiNr. v4vimDii A-rTwr or oowt Qr Pow
IIET 40IAT4 QSN-CRM � A-LFA:$t. PMCE VAFLY FOR SF�.o OAYS AFTER SEED IS: IWAULm
(4) AGR2E-THAT 666MIA;FODL9 IS NOlr ROP.ONj]ELE FOR GJWEJ 44l7dp C4Nl19TfCR15 6R OE3,ECTS.
AND ANYTA MAGE. TO CURBS, 51DEWA V% DRIYEAYS. Lk'6W.: 00`0!}Hpfi ITE W S: LN 7K ACOFSS AREA
(5) SEE IRAi ALL FEYQr4G,.GATM ANFD'OARA�G DOUR$ MEE� LI)a, CODES FOR A P06. EN'c'L=RE-
MDR M ?RkPU,57M INSP!�m
FILL -ROM ANEDIATELY AMQ� LASM. (FOLLOW IRST ' MZYMS —:M MOT -USE - RUBBER �GM*
TAKE. 90CE . T)i . 41 . THIS D�'AiMG - ig-. NE 'SOLE MMV'V mr.."A .6ms AV:'HAT 'Aly
IJSE'WTHrj.LFT'W.RlTTEN PE*t8i� 6CA.LlF0RNlA:F0QLS,-:lNCi IG q.WRib EI LAW,
QVMi3t APPROVES P"N. PIOCL,, AMU MWIJJrj LOCAL-nMIS ANP MA5 RE4{) TEIE.RESPflN51RILfREs lwflfl 140ums OqNE
QA7L
..81NImVNG POOL -PLAN FOR:
NAME
-H
KOZU R-ESIDENCE:
-
JAB AD DRESS CITY
OFFICE. REY7-- 7 PHONE':
LOT
-
TRACT PACE .,BOOK
MAP BOOK PAGE' NO. JCITY
MAIL ADDRESS
�qNSTRUCTCN ORFICE PH&NE NO.
SCALE OATE DRAWN BY SOLD BY CHECKEU BY:
i C) B-11
RE V1 S] 0 N.S. DATE
lr�q
2
A
wt:BE CHARGED IF lhL AFMOVED
lkpn RE ON
-A �4 112,4A r% hAn
-FUR
7F q
5 .
S F L rCTI ON S'
STONt /A
N
TILE &
BOULDERS li 141
APPRO-YED
FOR
DECK COLOR
JANDY
PEBB.'/PLAS . -AxeA4�+...
_SfQNATIU'RE
-ohd irri L Dro nage qcfm�or.- for'c>lor'l;ers orc pops,b y:
.6RAINAGE NOTE:'
y6l
=� n
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