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BPOL2016-006978-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 �c&t�t440" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPOL2016-0069 Property Address: 78361 DEACON DR W APN: 770210025 Application Description: RUBIN RESIDENCE / POOL SPA & WATER FEATURE Property Zoning: Application Valuation: $25,000.00 Applicant: REMBRANDT POOLS AND SPAS INC P 0 BOX 6411 MAy LA QUINTA, CA 92248 1v1 Owner: RUBIN RESIDENCE VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date:. 5/18/2016 � Q �-- Contractor: 1 9 2 J1b REMBRANDT POOLS AND SPAS INC P0BOX 6411 LA QUINTA, CA 92248 C11� of �aU11�pEpAR�ME1� (760)771-2121 NpEVE1-oPMEN Llc. No.: 800680 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 Professions Code, and my License is in full force and effect. License Class: C53, C27 License No.: 800680 CDate: 'Contraac 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 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.). (_) 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 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: ' WORKER'S COMPENSATION DECLARATION 1 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 polity number are: Carrier: _ 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: I- 15' I t; 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 ($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 Building Official 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 oft ' his permit. 2. Any permit issuedas 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 and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Date: �� %' f Signature (Applicant or Agent) FINANCIAL •• • DESCRIPTION ACCOUNT. QTY AMOUNT PAID PAID DATE •� ""BSAS'SB1433"fEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SWIMMING POOL/SPA 101-0000-42404 0 $181.29 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SWIMMING POOL/SPA PC 101-0000-42600 0 $98.62, $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER FEATURE 101-0000-42404 0 $181.29 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER FEATURE PC 101-0000-42600 0 $98.62 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for POOL/ SPA: $559.82 $0.00 TOTALS:.0 00 Description: RUBIN RESIDENCE / POOL SPA & WATER FEATURE CONDITIONS Type: POOL Subtype: Status: APPROVED Applied: 5/17/2016 MFA Approved: 5/18/2016 JJO Parcel No: 770210025 Site Address: 78361 DEACON DR LA QUINTA,CA 92253 Subdivision: TR 28611 Block: Lot: it Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $25,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: POOL, SPA & WATER FEATURE. THIS PERMIT DOES NOT INCLUDE EQUIPMENT WALL OR BBQ. PER 2013 CALIFORNIA BUILDING CODE Applied to Approved CHRONOLOGY CONDITIONS NAME TYPE NAME ADDRESSI STATE ZIP PHONE FAX EMAIL CONTACTS CITY APPLICANT REMBRANDT POOLS AND SPAS INC P 0 BOX 6411 LA QUINTA CA 92248 CONTRACTOR REMBRANDT POOLS AND SPAS INC P O BOX 6411 LA QUINTA CA 92248 OWNER RUBIN RESIDENCE Printed: Wednesday, May 18, 2016 9:40:56 AM 1 of 2 SYSTEMS � Permit Details PERMIT NUMBER . y City of la Quinta BPOl2a16-0469 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY SWIMMING POOL/SPA 101-0000-42404 0 $181.29 $0.00 5/17/2016 5/18/2016 5/18/2016 APPROVED SWIMMING POOL/SPA PC 101-0000-42600 0 $98.62 $0.00 WATER FEATURE 101-0600-42404 0 $181.29 $0.00 WATER FEATURE PC 101-0000-42600 0 $98.62 $0.00 Total Paid for POOL / SPA: $559.82 $0.00 INS PEGTIONS 9-0 01 INFORMATION ATTACHMENTS Printed: Wednesday, May 18, 2016 9:40:56 AM 2 of 2 09pp SYSTEMS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED DATE STATUS REMARKS NOTES 1ST BLDG NS (1 DAY) JIM JOHNSON 5/17/2016 5/18/2016 5/18/2016 APPROVED 9-0 01 INFORMATION ATTACHMENTS Printed: Wednesday, May 18, 2016 9:40:56 AM 2 of 2 09pp SYSTEMS Bin City of La Quinta Building &r Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Pe 't. Project'Address: - Owner's Name: b l�N 3 A. P. Number: Address: Legal Description: NGil Uv I &J City, ST, Zip; Contractor: J h5 � v LI �S.S Tele hon , Address: Project Description: Al 4U n City, ST, Zip: 1 �n CAcl ( .1 /+ (� c, jV Itc c, 4-,, Telephone: 7 7 7 � ................ 14G,/� State Lic. # : 4? 0d C irb City Lie. #.- Arch., Engr., Designer: Address: City., ST, Zip: h Telephone: one: Cons tructi n Type: e: Occupancy: Y P State Lie. #- airDemoJee)•wct hPe �c'rcle onn Alter Rep Name of Contact Person: S v sj l V L Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: _2&& 77 Estimated Value of Project: v v APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" 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:- '^! 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 DESCRIPTION PermitTRAK ACCOUNT • 1 $560.82 BPOL2016-0069 Address: 78361 DEACON DR Apn: 770210025 $560.82 BUILDING STANDARDS ADMINISTRATION BSA $1.00 BSAS SB1473 FEE 101-0000-20306 0 $1.00 POOL] SPA $559.82 SWIMMING POOL/SPA PC 101-0000-42600 0 $98.62 SWIMMING POOL/SPA 101-0000-42404 0 $181.29 WATER FEATURE PC 101-0000-42600 0 $98.62 WATER FEATURE 101-0000-42404 0 $181.29 TOTAL FEES • . $560.82 Q �e'1.+•`� � � 1. l� .� CITY OF LA QUINTA rmmimm DEVELOPMENT DEPART Date Paid: Thursday, May 19, 2016 Paid By: REMBRANDT POOLS AND SPAS INC Cashier: AOR Pay Method: CHECK 3135 Printed: Thursday, May 19, 2016 2:09 PM 1 of 1 •. <Y<TF AA<