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12-1367 (RPL)a. P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 CApplication Number: 12-00,001367 Property Address: 77355 CALLE POTRERO APN: 774-292-033-24 -000000- Application description: POOL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 192 Ti&f 4 4 a" Applicant: Architect or Engineer: � ----------------- I LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 1 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: C53 License No.: 672850 ,-Date:1I—? \_1ZContractor:l 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 ($500).: (_) 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 workhimself 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.). - (_) 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. , BAP.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 Owner: RYBAK 77355 CALLE LA QUINTA, ^ VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/21/12 POTRER CA 9225 Contractor: GATTUSO POOL CORPC 667 S. EUGENE ROAD PALM SPRINGS, CA 9 (760)327-7592 Lic. No.: 672850 ----------------------------------------------- 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 EVEREST NATL Policy Number 7600006501121 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. ate: l7'�— 12 :Applicant: 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 (5100,000). 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. 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. _ r 7 f -Date: _f �L Signature (Applicant or. Agen`t): ` y f} - LQPERMIT Application Number . . . . . 12-00001367 Permit BLDG POOL PERMIT Additional desc Permit Fee . . . 252.00 Plan Check Fee 163.80 Issue Date . . . . Valuation . . . . 25000 Expiration•Date 5/20/13 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 5/20/13 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 5/20/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 7 ------------------------------------------------------------------------ Permit . . . PLUMBING Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date Valuation . . . . 0 Expiration Date 5/20/13 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 Application Number . . . . . 12-00001367 Special Notes and Comments PLACE AT PRE -PLASTER INSPECTION. . EQUIPMENT ENCLOSURE NOT INCLUDED.' 150 L.F. LINE 1 1/2 PIPE. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 356.00 .00 .00 356.00 Plan Check Total 189.80 .00 .00 189.80 Other Fee Total 1.00 .00 .00 1.00 Grand Total 546.80 .00 .00 54.6.80 LQPERMIT 11/16/2012 13:36 7607784920 11/16/2012 13:36 7607784920 GATTUSO POOLS PAGE 03/E NOV-15-2012 THU 09:32 Aid DESERT CONCEPTS FAX No. 1EU ?UU YUUI r.uuz 11/14/2012 15:89 7607784978 ATTLEO POOLS PAGE 02/03 ii aq" w•M..r w w�.....�-N..r rr w�� 7 Ri CSA I I U5U r-UULZD n C r tA f N t*J G r r� �r cn • ~�-4 =L � 1" A o IN IN = IN�am r N 'Ti O N c a. Z7 A N -i ' O Q w•M..r w w�.....�-N..r rr w�� 7 Ri CSA I I U5U r-UULZD 11/16/2012 13:36 7607784920 GATTUSO POOLS PAGE 02/04 Bbl. rtC i • ' of La Qr..uItita . . kgng ar Safety MUm Pemlft P.O. Ba, 1504,70-495 Calle• Tampka 4.Qttinta CA 92253-,(760) 777-7012 Building P Application, and Tracking Sheet ' P opaAddtcss: a r: Nombcr ' Logal DacriP� may. ST Zip: '44 l Conuumr. %' 5Z) ®AP Add�ss: � `' Ptojetx Desaiptlon: g �'-' / c�F • city, �T. Zip=MAA 6gA11V'(d U ! Telvhm4ko Stdc Lau 4: City LTC' 4c .i Arcfi.,EW, D-Ipw. op ,hurl li 'Adds= Size' z,-P.pe 2 ,� 1'rlephone: - QoaType:. OogtPa0.Cy: - ' . 9taUc I.ia !i: Ptojed type (.*d o one): New Add'n Ahm Repan . Demo %� Na= cI Con= Petsan: Q? . �� 3q. Ft : 8 SWtirs # Uniflz Telepbiane 4 cf Coatad Person: Estiff D vstuo of f"e m oo i APPLICANT: DO NOT NRITE BELOW THIS UNE { / Submittal We Reed T) &CWG t'l�vui 1 „! MASON PISA Check eabadtted Its Amoaat Sh gdaral Cies, IRevkwaLrea(IyW4xrrKdous Ylau Chc.�c Deposit• . TMM Cabs. t Crlled Contact Pam Pisa Cbuk 13alanes, Tlttc 34 Cbici� Pian picked ap Cottsttacdou ' ' Hood &IV Pier+ pleas rembmitteA - Meebaiilcal Grading Plan r4 &evim ready toc rrec6oue mue Electrical Subtoatactor I,iet (Sled Contact Perm iPlumbb�g Grast Deed Pis us pidwo up H.O.A. Approval Ptans resabmMed Gradtsg IN HOME:_ asd Review, ready for DevdoPer Impact Fce Piantdag Appmval. Called Cotdact Petso m Pub. Vnm. Appr Date of perwlt kttm &bow Fits Total Permit Feet