06-3907 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 06-00003907
Property Address: 81937 COUPLES CT
APN: 764 -0,60 -038 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 30000
Architect or Engineer:
;0`loe
BUILDING &SAFETY DEPARTMENT
BUILDING PERMIT
------------------------------------------------------
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 Win full force, and effect.
U7' Class: C53 Licens Oo.: 822327
Date L' omrea:perjury
r•
OWNER -BUILDER DECLARATION
I hereby affirm under penalty o that I am exemptfrom 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, atter, improve, demolish, or repair any structure, prior to its issuance, also.requires theapplicant for the.
permit to, file a signed statement that he or sheds licensed pursuant to the provisions of the. Contractor's Stste
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 applicantfor a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) 1, as owner of the property, or my employees with;wages,as-their sole compensation, will'do the work, and
the structure is not Intended oroffered forsaW(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 ere 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 ofsale.).
(_)
1,, as owner of the property, am exclusively contracting with licensed contractors to corstruct.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
pursuantto the Contractors' State:License Law.).
(_ 1 1 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 theperformance, of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/07/06
Owner:
JAMI ULLRICH
81937 COUPLES COURT —
LA QUINTA, CA 92253 D- L -NA U
' r d @ 2006
Contractor:
CLASSIC POOL AND SPA
CITY OIPL, QUIMTA
79300 CALLE SONRISA FIMAMCIEDEPT.
LA QUINTA, CA 9?253
(760)`360-8242
Lie. No.: 822327
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 have and will maintain areertificate of consent to self -insure for workers' compensation,as provided
for by Section.3700 of the Labor Code, for the,performance,of the workfor 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,workforwhich this permitis issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
�[ 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 - or Code; I shall forthwith:c ly.with those provisions.
AI�-S pplicam:
WARNING:. FAILURE TO`SECLI WORKERS' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP T07ONE_HUNDRED THOUSAND
DOLLARS (8.100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3705 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 persomat whose request and for
whose benefit work is performed under or pursuant toanypermit 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 forany 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 c my ordinances and eta awsrelating to building construction, -and hereby.auth a epresentatives
of this my to enter upon ;t ve mentioned property for inspe on purposes.
ate r r 'Si lure (Applicant or Agent):. _
Application Number . . . . 06-00003907
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . 284.50 Plan Check Fee 184.93
Issue Date . . . . Valuation. 30000
Expiration Date . . 5/06/07
Qty Unit Charge Per Extension
BASE FEE 252.00
5.00 6.5000 THOU BLDG 25.,001-50,000 32.50
Permit . . . MECH POOL
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date Valuation. . . . . 0
Expiration Date 5/06/07
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 5/06/07
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 3.0.00
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 33.00 Plan Check Fee 8.25
Issue Date . . . . Valuation . . 0
Expiration Date 5/06/07
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
LQPeRMrr
Application Number . . . . . 06-00003907
------------ - _ _
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged
Permit Fee Total 388.50
Plan Check Total 210.93
Grand Total 599.43
LQPERMII`
Paid. Credited Due
---------
.00 .0.0 388.50
00 .0.0 210.93
.00 .00 599..43
JC
f�
Bin ® City .of La Quanta
Building a Safety Division
Peahk B R,O. �01 Box 1504, 78-495 CaUe Tampico U Quanta, CA 92253 - (760) 777-7012
�J
Building Permit Application and Tracking Sheet
Projcce.Addras: 9' 17 3 7 'Co v 5 C
ou►•ner's Name: U t C -
Revd
A. P. Number.
TRACKING REUM FEES
Address•. g
Crr.
Le gal .Description:
City. ST. Zip:. d .v T 4
s%•r
Contractor. G, . m.c?LS-*R#S
l Cala.
FTclephow
Address: p G
Plan Check Depositsts
ject Description:
City, ST; Zip:A*40e.Jev ?It
-* . 7 2 S- -2
m L vR- 5"4*
Plan Cheek Balance
Telephone: 2. m Z-4 G 6
Gia.
Plans licked: up
State Lia p : 22..3 ?
City Lic. a •
Atch, Engr. Designer:
o it `e r A/
Grading pian
Address: TOO CdAc e-
SM.&.P! S A
2" 'Renew. ready for cot. Anne
Metrical
City: ST.:Zip:lJ1w-0Z-1
' G! 922 0"-7
Telephone:
Plumbing
Conswaion Type: Occupancy:
Project type (circle one) ew Add'n After . Repair Dam
Name,of Contact Persow A�aA
o 7e--
Sq. FL:Li q a
M stories.
N units:
Telephone.# of Contact Person:
to
anted Value of Project: B Q i d c' -
APPLICANT: DO NOT WRITE BELOW THIS UNE
seE
Revd
Reed
TRACKING REUM FEES
Plan Cbeck'subtained
l Item Amount
l Cala.
Reviewed. ready, for corrections
Plan Check Depositsts
Called Contact Perna
Plan Cheek Balance
Gia.
Plans licked: up
Coastrttetioa
Flood plass pias
Plans resubmitted
Mechanical'
Grading pian
2" 'Renew. ready for cot. Anne
Metrical
Subeostactor List
Caned Contact Person
Plumbing
GrantDeed
Plans picked up
S.M.I.
H O.A. Approval
Pians resubmitted
Grading
IN HOUSE:-
to Revenr. ready for corcectionsfissue
Developer impact Fee
!lanais= Approval
Called Conacteerson
A.t.P:P.
Pub. Wks. Appr
Date of permit issue
School. Fen
Total Permit Fees
Classic I'c�ol5 & Spas
_'S rr�iix
1'.rprric•u, .• .u,.l qu�)!in•
Specializing in:
Grading h a
-Custom m Pools :ind Spar
_Falco Solar Pool Heating Systems
-Pool and Spa Remodels
-Saltwater Purification SystCms
-Deck Remodels
-Alunmwood P:ttio (:o%-crs
Conwei
4A hce,phunc: 74q. 160-$31,
-till phone: 761,-_i0 22M
-Fwc 760-360-27)7 -Email. kkochnliinperosn.com
CITY OF IA QU NTA
BUILDING & SAFET-I DEPT.
APPROVE
FOR CONSTRUCT ON
DATA r,�BY
OWNER to fence pool area and install self closing and self latching gates per code.
NOTE: No dirt I be removed, returned or graded after day of excavation.
Designed by ? NOTE: Relocation of equipment pad will result in additional cost to owner.
NOTE: Fill pool immediately after plaster (follow instructions). Do not use, rubber hose.
KERRY R. K O E H N"L E I N NOTE: Do not tum on pool light when pool is empty.
PHONE -360-0012 NOTE: Wet down concrete shell at least twice dairy for seven days after shell is installed.
I have reviewed this plan and hereby approve total plan & specifications.
DATE CUSTOMER SIGNATURE
POOL SIZE I rl x—_15Depth 3 L xS_ xZ
Surface
Perimeter_
EXCAVATION Access j.. k
Grading h a
Dip From Sh,► U-0.."
Obstacles WA LL
.Walls Removed V _04
Replaced e- S
Misc.
PLUMBING Filter
Site yS�
Pump N t Size0
Booster Pump
Skim Run 3-1" Main Drain
Ret 3
Fill Une 41uTa Purifier AJA
Tamil. CSR`
Auto Cleaner 5 h A 11:�,
Htr Type SAC Size y o0
Gas OF _40
FOUNTAINS—SPRAY HOS—WATER EFFECTS
Type � 2�,Lt( S �iee�J
Sin t
Plumbing Length
Booster (50g, TypeSf t
Valves
Sae 2
Misc.__q I e,daC—rl &J* -"e
'-'T-e;5
STEEL GUNITE Eno 1&-S
Sur -charge Ali
6' R98 12-_'20 18'
24'
Step Risers ' Spa Wall Width
Benches - 5 #Pk Love Seats !v
Spa Dam Wali 12r& 'K S fat�/a Notch �� G
Misc. sPxi ty r ae a>a-m
ELECTRIC Total Run L/F (rJ Fibeoptic
(Remote lluTeLtcTmttGA 7 Spa_ V 60-r-ro.d
Mise
TILE WAhfet # Ac Coping Nd
step & such Tile# e.0%
Misa�iass—Etc.
DECI(ING Sq Ft 3 �� Type,S_ L_ Color T,9l0
Nat Concrete Sq Ft Cantilever ) e • _
D.O.D. LIF _ Step Risers
Misc.
SPA Sae 9,X4 Area I e Peri .
Pump d .a..+ Blower_ Zko Spilhnray�_5_-
JessG SrA It) Step Light J< Earn
Misc.
INTERIOR FINISH .3 m e/A. Color Acie*d ��•v
Other
OWNER PA 1 0 LL R LC
ADDRESS 3 ? i^mr.�Crf Cr
CITY - ,, SOLD BY2tZ_"_ DATE -to -3o -p f
PHONE (H) 0 7 S' I (W)111 -V70 631V
DRAWN BY l Q DATE //-�7-
03;'16/2006 THU 131:.21 FAX 760 777 7105 Finance, La,9uinta
P.O. Box 1504
[0004/004
(760) 777-7000
LA QUINTA, CALIFORNIA 92247 FAX (760) 777-7105
CITY OF LA QUINTA.
WORKER'S COMPENSATION DECLARATION
If your company. has compensated employees, a copy of your WORKMAN'S COMPENSATION POLICY
toust,accompany your BUSINESS LICENSE APPLICATION, showing the dates of coverage, including the
expiration date,.and the dollar, amount. TIiiS PROOF OF COVERAGE MUST BE RECEMED BEFORE
YOUR BUSINESS LICENSE CAN BE PROCESSED.
IF YO BUSINES3.IS BF1NG OPERATED F1it:M A PRIf :4 TE RESIDENCE IFfmx LA QUINTA. A HOME
OCCUPATION PERb11T3RE'QUIP&_) BEFORE. BUSINESS LICENSECAM BE1.SSUED.
Every employer who applies for a Business license -or License.renew it which is.to be issued pursuavt to Section
3710.1 of the Government code -or Section 7284 of the Revenue and Taxation Code-SHALt- , COMPLETE AND
'SIGN A DECLARATION THAT STATES ONE Or THE FOLLOWING.
I HEREBY AFFIRM, UNDER PENALTY OF PERJURY, ONE OF THE FOLLOWING DECLARATIONS:
(Check One)
1 Have and will maintain a CertiGcaie of Conseni to self=insure for Worker's
Compensation, •rs provided by Section 3700 for theduration of..any business
conducted for which a Business License is issued.
1 Have and will maintain Worker's Compensation Insurance, As required by
Section 3700 for the duration of any business conducted for which a Business
License is issued.
WORKER'S COMPENSATION INSVRANCE CARRIER:
POLICY NUMBER: EXP1%t TION DATE:
(IF YOU DO NO VE ANY EMFLOYEES,PLEASE INDICATE BELOW)
�_ v that in thr crformantt
p of any Business activity for which a Business License is issued,.
I shall not employ any person in any manner so as to become'subject to the Worker's Compensation.Laws of .
the state or California, and I agree that if I should become subject to the Worker's Compensation provisions of
Section 3100,-1 will -provide the City with it Policy or Certificate copy within tent (10) days of the chknge n
requirements.
•!1,lY!}•!!Mt!lk lit!!!},ti!!!R}k!:!}A.!l�pIRA!!!}}!,{.}Rt},t},y!!}}},R!}AR/6sR'/k1rR}'!}tRw if Rihl Rf lA RAMA1tR
Date
WARNING: FAILflRE TO ECURE WORKER'S COhIPENSATION COVERAGE IS UNLAWFUL,_4ND
SHALL SUBJECT AN E LOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO S 100,000. IN
ADDITION TO FLIES NWPENALTIES, ADDITIONAL COMPENSATION DAMAGES, INTEREST AND
ATTORNEY'S FEES AIAY-BE ASSESSED TO VOU AS PROVIDED IN.SECTION 3706 OFTIiE:LABOR
CODE.
CITY OF LA QUINTA SUB -CONTRACTOR LIST QQ
JOB ADDRESS PERMIT NUMBEN OWNER' A BUILDER
This form shall be costed on the job with the Building_ Inspection Card at all times in a consnicuouoID ace. 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. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade / Classification
Contractor
State Contractor's. License
Workers Com ensatlon insurance
Cl Business License
Company Name
Classification
(e.g. A, 9, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp, Date
(xxlxx/xx)
License Number
Ixxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12) _
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ROOFING (C-
SHEET METAL (C,!43)` "
GLAZING (C-171
INSULATION .IC -21:'. �.
SEWAGfi DISP .IC=42)
PAINTING IC=33)'.
CERAMIC: TILE I6-541'.:
YCABINETS� IC -61'
'"ND.S.CAPING'(C=27 ' :.
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