14-0127 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
14-00000127
Property Address:
53540 DEL GATO DR
APN:
770-370-002- -
Application description: -
POOli - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
5000
TW!t
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"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: p Arch ite t or ineer:
4
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 is in full force and effect.
Licens Class: C53 License No.: 856835
Dat:p y � r Contractor:
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 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 (Sec. 3097, Civ. C.)•
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
CLEARWATER, RONALD
1042 W LAKE SAMMAMISH PKWY SE
BELLEVUE, WA 98008
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/13/14
oI
1
Contractor: 1
VACATION POOLS INCCi? 2014
EB
P.O. BOX 10940
INDIO, CA 92202
(760) 775-0468 CITY OF LAQUINTA
Lic. No.: 856835 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 STATE FUND Policy Number 1948584-2013
_ I certify that, in the performance of work for which this permit is issued, I shall not employ any
person in any manners as to b co a subject to the workers' compensation laws of California,
and agree that, if I sh Id�bec me ubject to the workers' compensation provisions of Section
3700 of the Labor C d 1I s all f hwith comply with those provisions.
�Dat� 13 Applic�DITION
WARNING: FAILURE TO SE CORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN 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 ermit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that th above information is correct. I agree to comply with all
city and county ordinances and state laws relating to by ding construction, and hereby authorize representatives
of this countytoen/yter upon the above-mentioned pr rNL/for inspection purposes.
Bate�J V 1 Signature (Applicant or A ent)-
Application Number . . . . . 14-00000127
Permit . . . POOL 2013
Additional desc . .
Permit Fee . . . . 178.75 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 8/12/14
Qty Unit Charge Per
Extension
1.00 178.7500 EA MISC POOL/SPA
178.75
----------------------------------------------------------------------------
Special Notes and Comments
TWO (2) WATER FEATURES AT COURT YARD
[POOL ENGINEERING INC] THIS PERMIT DOES
NOT INCLUDE BLOCKWALLS OUTSIDE OF WATER
FEATURE. 2013 CALIFORNIA BUILDING CODES.
February 13, 2014 2:59:57 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, POOL
97.24
Fee summary Charged Paid Credited
--------------------------=------------------------------
Due
Permit Fee Total 178.75 .00
.00
178.75
Plan Check Total .00 .00
.00
.00
Other Fee Total 98.24 .00
.00
98.24
Grand Total 276.99 .00
.00
276.99
LQPERMIT
Qin #
City Of La Quinta
Building 8T Safety Division
P.O. Box 1564, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheqt
Permit #
Project Address: j y� % d•
Owner's Name: e �' �(��' (,�/
A. P. Number:
Address: �jJ L G �j 9 � J
Legal Description:
City, ST, Zip: LQ A uw f'+' (A
Contractor: Q�i(l /C!J O(,' ZJ
Telephone:
Address: ��J�7 COOL Ct�G�I yr
Project Description: —&14A�Q f ✓I,.J
City, ST, Zip: ' rta f a
Structural Calcs.
hone: Tele G
P o . 47r� S
Reviewed, ready for correctionsN
State Lic. # :
City Lic. C
Arch., Engr., Designer:
Address:
Called Contact Person
City., ST, Zip:
Telephone:
nstructiori Type: Occupancy:Co
.
State Lic. #
?' if
ly'{Y''•�:i<�>:�:vii'ii::iiv':'<'•y:,'r'.;'•: i. i.:.,i. .,..
.........:.............:............................:
-
Add'n Alter Repair DemoProJect hPa circle one : New
Name of Contact Person:ej'CZQ� (jfy .
Sq. Ft.:
#Stories:
# Un'ts:
Estimated Value of Project: 570001
APPLICANT: DO NOT WRITE BELOW. THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for correctionsN
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance •
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21' Review, ready for coi•rcctiossu
IT
Electrical
Subcontactor List
Called Contact Person 77
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted 00,
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Wkta fiwffv" bog, 14en Co�.totp, .5T4.0.4p*40 04L..�Mafw4op4c,
R'DOt��c, Dl�c..�wwt. d� •
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