08-0481 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
"`&ttt 4 4 Q"
Application Number: _06_-_0_T0_6_0_4_81—
Property Address: '81846 RANCHO SANTANA DR'
APN: 767-200-999-5 -312023-
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 24500
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury tha am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Busines a d io Code, and my License is in full force and effect.
LicenseClass: C5 Lic a No.: 802919
at C ractor:
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 Is 500).:
(_ 1 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 or offered for sale fSec. 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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 fSec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
GREG TERLECKY
81846 RANCHO
LA QUINTA, CA
(760)777-9920
SANTANA DRIVE
92253
Contractor:
AZURE POOLS AND SPAS
P.O. BOX 10641
PALM DESERT, CA 92255
(760)322-7665
Lic. No.: 802919
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/21/08 ..
O �
MAR 27 2000
CITY OF LA ALIINTA
FINANCE DEPT
------------------
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 DELOS . INS CO Policy Number 01DKPM12002794
I certify that, in the performance of the work for which this permit is issued,-] shall not employ any
'person in any manner so as to become jest to the workers' compensation laws of California,
an agree that, if I sfol bj ct t th workers' compensation provisions of Section
0 of the Labor Cfort i co ply 'th those provisions.
a scant:
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.
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. '
certify that I have read this application and state that the above information is correct. I agree to comply with all,
city oclourdinan es and state lawsrelating to buil ruction, and hereby authorize representatives
of tha pon the above-mentioned prope or spa ' n oses.
DateSi n e (Applicant or Agent):
Application Number .
. . . . 08-00000481
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee
.252.00 Plan Check Fee
163.80
Issue Date`
Valuation . .
. 24276
Expiration•Date
9/17/08
Qty Unit Charge
Per
Extension
BASE FEE
45.00
23.00 9.0000
------------------------=---------------------
THOU BLDG 2,001-25,000
------------------------------
207.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
9/17/08
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
9/17/08
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
9/17/08
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
Permit . . . . . WALL/FENCE PERMIT
LQPERMIT
Application Number . . . . . 08-00000481
Permit . . . WALL/FENCE PERMIT
Additional desc— .
Permit Fee . . 15.00 Plan Check
Fee
.00
Issue Date Valuation
. . .
. 224
Expiration Date 9/17/08
Qty Unit Charge Per.
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA, 14 L.F. 4' EQUIPMENT WALL,
CITY STANDARD. ALARMS/BARRIERS SHALL BE
IN PLACE AT PRE -PLASTER INSPECTION..
Fee summary Charged Paid Credited
-----------------------------------------------
----------
Due
Permit Fee Total 371.00 .00
.00
371.00
Plan Check Total 189.80 .00
.00
189.80
Grand Total 560.80 .00
.00
560.80
LQPERAUT .-
Bin #
City of La Quinta
Building 4 Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # \
Project Address:DWI
A. P. Number:
Legal Description:
Contractor: H-W(�� c)
Owner's Name:
Address: I ffi
City, ST, Zip:
Telephone:
Address: �! a�� D
�'
11
Project Desc ipt' n:
City, ST, Zip:AfIVW
t
Telephone:
City Lic. #:
State Lie. # :
Arch., Engr., finer: Desi
`
Address: N
City, ST, Zip: Gr'L
Telephone: I ,97 fl)
State Lie. #:
r
Name of Contact Person:
/ / q—
Construction Type: Occupancy:
Project type (circle one) ewAdd'n Alter Repair Demo
Sq. Ft.:tories:
#Units:
Telephone # of Contact Person: �— Q
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
.�
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plan
2"d Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans. resubmitted
Grading
IN HOUSE: -.3rd
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval .
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
024Q�
a 41 ;?Ieo
�= tip
'
i u
i.
'wC�++ P; L
LV: s ''-`3. 80-2919
POOL SPECS
POOL SIZE: 15' X 30'
POOL AREA: 397 SF.
POOL PER: 99 FT.
POOL DEPTH:
SPA SPECS
SPA SIZE: 7
SPA AREA: 49 SF.
SPA PER: 28 FT.
EQUIPMENT
PUMP:
FILTER:
HEATER:
POOL LIGHT:
SPA LIGHT:
FINISHES
DECK AREA: 813 SF
PLASTER:
TILE:
1 "=S' SCALE
GREG T ERLEC KY
Terlecky Residence
81846 Rancho Santana Drive
La Quinta, Ca
LOT tt : 3 RA NCI -IO SANTA NA
Azure Pools & Spas
PO Box 10641 '
Palm Desert, CA 92255 ALL PROPERTY LINES
760.322.7665 HAVE EXISTING 5'