04-6265 (RPL)BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . .04-00006265 I Date 9/10/04
Property Address . . . . . . 53360 AVENIDA JUAREZ
APN: 774 -071 -006 -19 -000000 -
Application description . . . POOL - RESIDENTIAL
Property Zoning . . . . . . . COVE RESIDENTIAL
Application valuation . . . . 13000
Owner Contractor
------------------------ ' ------- = ----------------
DAPHNE GILBERT AZURE POOLS AND SPAS
53360 AVENIDA JUAREZ P.O. BOX 10641
LA QUINTA CA 92253 PALM DESERT CA 92255
(760) 322-7665
WCC: STATE FUND
WC: 0001705853 03/01/05
CSLB: 802919 01/31/06
CCC: C53
----------------------_------------------------------------------------------
Permit . . . BLDG POOL PERMIT
Additional desc
Permit Fee . . . . 135.00 Plan Check Fee 87.75
Issue Date Valuation 11917
Qty Unit Charge Per Extension
BASE FEE 45.00
10.00 9.0000 THOU BLDG 2,001-25,000 90.00
Permit . . . . . . MECH POOL
Additional desc
Permit Fee 24.00 Plan Check Fee 6.00
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per
BASE FEE
1.00 9.0000 EA ..MECH FURNACE <=100K
--------------------------------------------------------
Permit . . . . . . ELEC POOL PERMIT -RES
Additional desc
Permit Fee. 45.00 Plan ChCck�
Issue Date . . . . Valuationxk
Qty Unit Charge Per
BASE FEE
1.00 30.0000 EA ELEC PRIVATE SWIMMING P
Extension
O 15.00
9.00
Fee,,? O Q 11.25
0
Extension
15.00
OOL 30..00
r•
P.O. BOX 1504
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING &t: SAFETY DEPARTMENT
Application Number: `2.4- &01&5 Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
N/tlot
Lic. No.:
BUILDING PERMIT DECLARATIONS
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
ode, and my License is in full rce and effect.
License Class CSS 4 �ense No. 0p D Z 9 l q
/gate G%^ -04- --Gontractor /t2.1/1Z)E / 001 s . 1 A5
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 fora permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' 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
Y d. My ers' C mpensation , ante carrier and olicy num r are -
policy Number
_ I certify that, in the performance of the work for which this permit is issued, 1 -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
'?-1-7-04- forthwith comply with those provisions.
/Gate / ~ 1Jrt—04- ✓J
WARNING: FAILURE TO SECURE WORKED COMPENSaMON 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.
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 9 at
Lender's Address
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 Ouinta, 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.
i� nature (Applicant or Agent):
w
r
Page 2
Application Number . . . . . 04-00006265
Date 9/10/04
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Permit PLUMBING
Additional desc . . `'
Permit Fee 33.00 Plan Check
Fee
8.25
Issue Date . . . . Valuation
. .
. . 0
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
Additional desc
Permit Fee . . . . 27.00 Plan Check
Fee
.00
Issue,Date . . . . Valuation
1083
Qty Unit Charge Per
Extension
BASE FEE
15.00
6.00 2.0000 HND BLDG 501-2,000
----------------------------------------------------------------------------
12.00
.
Special Notes and Comments
POOL/SPA, 50 L.F. 5' GARDEN WALL,' CITY
STANDARD.,ALARMS/BARRIERS SHALL BE
IN PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited
Due
-----------------------------------------------
.Permit Fee Total 264.00 .00
.00
----------
264.00
Plan Check Total 113.25 .00
.00
113.25
Grand Total 377.25 .00
.00
377.25
r
ZT T"
A u -KE
POOLS & Sl' -)AS
LIC# C-53, 802919
POOL SPECS
POOL SIZE: 13'X 166"
POOL AREA 215 SF
POOL PER: 60 FT
POOL DEPTH:
SPA SPECS
SPA SIZE: 5'X 7'6"
SPA AREA:
SPA PER:
EQUIPMENT
PUMP:
FILTER:
HEATER:
POOL LIGHT:
SPA LIGHT:
FINISHES
DECK AREA 175 SF
PLASTER:
TILE:
1 "=8' SCALE
GILBERT
RESIDENCE
ADDRESS: 53-360 AVE. JUAREZ
CITY: LA QUINTA
LOT#:
CITY OF LA IIMTA I
BUILDING & SAFETY
AP OR®VE ION
FOR
DATE �' a BY 57
p REINSPECTION FEE OF
0,
WILL SE CHARGED IF THE AP NOT co
PLANS AND JOB CARD ARE
THE SITE FOR A SCHEDULED
INSPECTION.
NO EXCE'TIONT