09-0464 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
09-00000464
Property Address:
79190 SHADOW TR
APN:
649-030-069-36 -31310 -
Application description:
POOL - RESIDENTIAL
Property Zoning:
HIGH DENSITY RESIDENTIAL
Application valuation:
20000
Applicant: vl�4�
Architect or Engineer:
t—k—, J - ��
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I 2OWNER-BUZILDERCLAgRATION
isi ns of Chapt 9 (commencing with
Section 7000) of Division 3 of the Business aa my Licens is in full force and effect.
License Class: C27 C53 36590
Date: Contractor: .
CLARATION
I hereby affirm under penalty of peri/y that 1 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 70001 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.).
1 _ I 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.).
I _ I I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
a 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:
KEITH GIBSON
79190 SHADOW.TRAIL
LA QUINTA, CA 92253
(760)771-3345
Contractor:
DESERT PARADISE OUTDOOR
40101 MONTEREY AVE #B1
RANCHO MIRAGE, CA 92270
(760)601-6003
Lic. No.: 365900
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/13/09
-----------------------------=�y------- - - - - --
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 EXEMPT Policy Number EXEMPT
_ 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 s to become subject to the workers' co ensation laws of California,
and agree that, if I sho become sub'ect to the o ers' comp anon provisions of Section
f'F/-3377-010 of the Labor Co I shall fort ith comply i those pr isions.
Date: �C,' Applicant: _
WARNING: FAILURE TO SECUR ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO C INAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN AD ION 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 informatJiscorr. I agree to mply with all
city and county ordinances and state laws relating to buil ' g construc ' nauthorize a resentatives
of this couty to mer upon the above-mentioned proper for inspec n
Date: s� d Signature (Applicant or Agent):
Application Number
09-00000464`
. Permit . . .
MECH POOL
Additional desc
,
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date,
Valuation _
0
• Expiration.Date
11/09/09
Qty Unit Charge."
-Per
Extension
BASE FEE
15.00
1.00 , 11.0000
EA MECH FURNACE >100K
11-00
Permit . . .
BLDG POOL PERMIT '
Additional desc .
Permit Fee
207.00 , Plan Check Fee
.134.55
Issue Date . . . .
Valuation . . . .
20000
` Expiration Date
11/09/09
,
. Qty. Unit Charge
Per
Extension
BASE FEE
'45.00
18.00` 9.0000*
THOU BLDG 2,001-25,000
162.00
Permit
ELEC POOL PERMIT -RES.
Additional desc .
Permit Fee
45.00 Plan Check Fee
11.25
Issue Date,
Valuation . . .
0
Expiration Date .
11/09/09
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
11/09/09 R
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
LQPERMIT
Application Number 09-00000464`
Special Notes and
Comments•
PLACE AT PRE -PLASTER INSPECTION.
- EQUIPMENT ENCLOSURE NOT INCLUDED.
200.7 -
CODES -
---------------
Other Fees .'
. . . . .... eBLDG STDS-.ADMIN (SB1473)
1.00
Fee summary
Charged
Paid
Credited
Due
. Permit Fee Total
311.00
.00
.00
311.00
Plan Check Total
160.55
.00
.00
160.55
Other Fee Total
1.00-
.00
.00
1.00
Grand Total
472.55
.00
.00
472.55
FROM :GOLD COAST
FAX NO. :7142862630 '. Mar. 24 2009 03:09PM Pl
IOMEOWNERS ASSOCIATION
Archite Wml improvement VE
Application and kOew Form
W out, Tore-^.eM.. j LLC.,
Name (owner) 6, 5 Date D 3
Property Address - s a 1' Q; Phone �5._
-- ---
Nature of Improvement '4 �- j,IIy-�
Color (If appkabk) I Location of q*kcabte)
Dimensions (if applcabte) �t A 410.Gh
Construction N%Wal (If eppllcable
Suppler Approx. Cost $ 2a
ONE SET OF PIANS FOR A.LIMMOVEMM MUST BE ATTACHED TO THIS APPLICATION TO.SHOW THE
LOCATION AND DINIENSIONS.
N Net4hb0tho0d Awareness For Rrderts Q azratl0n MCtllti t tZ uccrLLsrve-uss Damon mea cu�a is
canemi commotl Q
The Ast enation requires that your closest tteighbor(s) be made ewer¢ of the nwod kedons you
ere OaMrtg and that they )e given opportunity to egress to the Association their egreet =t or disagreement
bcfare the Board acts on I SEs application. ran to obtain these sigiatures A delay the appmml prows. Piease
obtain the signatures of ye y nelohbor(s) on both sides of you. (end units �e o* one signature). Neighbors
who disagree will be requ 'ed to state theta ob}ecdon(s) In open forum at the nett Mooed meeft failure to do so
W11 constitute an abandon Hent of tht disagreement.
i
send to: . HOMEOMASASSOCW'RON
ArCNOtc"kVkwCWff4 Mt0,
CIO Gow Cow EhWPtM
200 E KaMM Ave • Oreree * CA 92867 Fax (714) 2U-2680
FORINU AL USE ONLY
Approved On (date)
( ) Appwed With Condldtonsl
Dlsapp oved On .
Reason far Disapprovail
2'd 0£'32BB2t TLT :01 0L20L826t,6 )t : -w Rw ti£O:I T 6002_02-8dw
£/2'd L098b£809LT:01 0L20Le26b6 N3d88:WMU U22:L0 6002-TT-AbW
• v �� U' Q� W .
r
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SPA.
6'X8'@ +18" RAISED
_(6) JETS
7 STACK STONE
SPILLWAY
v —STONE ON OUTSIDE
OF SP A
—250 WATT WHITE LIGHT
—STAGGERED JETS
1) 400,000 BTU HEATER
1) VARIABLE SPEED CIRC. PUMP
1) 425 SQ. FT. FILTER
1) 1/2 HP SPILL PUMP
1) SKIMMER
1) i5 INTELLITOUCH INHOUSE
CONTROLf4BUTTOM SPA
SWITCH
1) INTELLICHLOR SALT SYSTEM
1) 500 WATT WHITE POOL
LIGHT
1) 250 WATT WHITE SPA
LIGHT
MOVE & REPLACE ACCESS —
QCKWALL TO MATCH (E) BY
OC
) W.I. GATE TO SWING AWAY
OM POOL AREA SELF CLOSING
SELF LATCHING
I-Iraul To >rreer Y eq _ _ I±Irt.-., ;
(E) A/C UNIT STEEL-
I5 INHOUSE CONTROL
� � � � - U 1� T - � ,
..STUB DRAIN LINE TO
THIS LOCATION. t
LANDSCAPER TO DO t
GRASS, PLANTER
DRAINS & RUN DRAIN
LINE TO STREET
_.-.—(E) CONE. STOOD
f:
—DOOM ALARM
GAS
Lij ca
ELECTRIC
w
j!
l
t
t
T'�' Q�, j DOOR ALARM
KEITH H & EL (E) CONC. STOOP
r �
GIBSON /Z
RESIDENCE..'
9aL= I
10 I_
,
(E) DRIVEWAY
i
t
Jj 1
II t
I f "+
Ill,L..�a i I�.� �4. S���'E-I .)E '
DATE_
BREAKDOWN:
ADDENDUMS DATE SELECTIONS
POOL:
A X49 ' SQ. Fr.
P=94'
E+E`Y COLOR
SPA:
Decco Dain: Yes - No II
A=38 SO. FT
P=22'
a . ruLr
SPA CANT.
AP:
P=56'
ContractorsI
PLINTHS
SCALE:
CANT. CAP:
SPA PLUMBING: MASONRY:
P=28'
POOL CANT.
AP:
P=73'
prolzcrtF Lim Wall
TOTAL CANT.
AP:
P=157'
119, _ 1'-&'
POOL DECK
RBB Facing
A=573 SQ. F'-.
COVERIED PA
0
DECK
GUNIi'E: Stone Step;
2 .
.
OTAL DECK
A=865 SQ.
Special Nlisc. Veneer on Outside o1 cilia
DEMO
A=292 SQ. F
4 Type
Special Misc_
1 BOAS
t -
AWA Q A
SINCE
t. NAFIQ AL
SPA a P .UL
INSTIT41TE
JOB#
ADDENDUMS DATE SELECTIONS
- TIe llltl vineTs ._ rain .inn
Special Mist.. Curb Care: Yes - No
E+E`Y COLOR
Decco Dain: Yes - No II
special 1yliw.
a . ruLr
POOL PLUMBING: ELECTRICAL:
t
ContractorsI
`special Mic;c_ Special Misc.
SCALE:
SPA PLUMBING: MASONRY:
REVISION:
Spccial Mise Sp ll.hau Ty
CASITAA
prolzcrtF Lim Wall
® ®
Fire Pit
119, _ 1'-&'
RBB Facing
DATE: 05-11-09 j
l
Equipment Wall
:rla
(E)
GUNIi'E: Stone Step;
Fireplace
Special Nlisc. Veneer on Outside o1 cilia
Stolle IN'2terlillg
Special Mix:.
t
WOOD: TILE`:
Specill Mix;. Group 1,23: Yes No
:I
(E) LAI?SCAPE
.
7 l
Tile Trim: 1 eC N_
0 Steps 0 llcnchc5 C Love Se its
SALESMAN .}I
Special Miw,
IRON:
Special Mise. PLASTER 1 PEBBLE:
i
4 Type
Special Misc_
1 BOAS
t -
AWA Q A
SINCE
t. NAFIQ AL
SPA a P .UL
INSTIT41TE
JOB#
ADDENDUMS DATE SELECTIONS
I STONE
E+E`Y COLOR
4 PEBBLE!PL fl STER
a . ruLr
71 1 cr ciu2 cowre
t
DOOR ALARM:
t
ContractorsI
SCALE:
REVISION:
CASITAA
® ®
119, _ 1'-&'
16'
DATE: 05-11-09 j
l
0' 4' 81
:rla
(E)
t
HIRIE LOCA • BUY LOCAL
:I
(E) LAI?SCAPE
.
SALESMAN .}I
LCAT Nt3_
t
;..
MAP BOOK REF.
TRACT NO.
t
a
i
t
T�ryy�
`iii Assciclftion of_.
Fool Spa Pr essiona
Preparedspeiaii
p
1L3 _.QE
t
street 79-190 *HARON
TRAIL
x.
L.1IioI NIS
pity LA QUINTA CA
92253 fUESERT COVE)
4
ANDSCAPE
EL 360) 451-1520
KEITH (360) 79C)-9679 yen �n,n�e (
CONT;pnQ�e
:ACTORS
Office (949) 824-9818
Fax ACCESS KEY KEY 9330
Member` -'SSS
CLATION
{
c'
I
Bin #
City of La Quint'a
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-70.12
Building Permit Application and Tracking Sheet
pp g
Permit #
D�
Project Address:_ 1 U
Owner's Name: L,g s' Z) N
A. P. Number: S NAS
Address: -. 7 — �� 9A1 L.
Legal Description:
City, ST, Zip: .0 l 2-
Contractor:
Contractor:
��s><:»>:�:is>:s:;:«<:>::»:::;:>:i>:>:::?>:
Telephone: 60 d — 6(p'
• :•:.:;?{-r.,.::;;i.iii::.;:::;;:<:::::;?..iii:
111-11,11
f:i s>:?f:i::>;s::>::<><:>?:<:::::;wz'•>
�>.•'i'>.?'%' ::K :G'!•ii'ii.Siyi`•i}iiiix:
Address: 20 Co/�rC�(�f �
ProjectDescription: pBZ IPA -
City, ST, Zip:
Telephone: ? — Co-1-4616��.;:_::.::<.:;;:{;<;i:�;.::::<<;
::^�:�:''•.:•::•
:::$k••ii1iii'ri:iiiiii:v:}:',v,'v r({F:.'•iii'i::i.:::ri;;
ii.Q.�U''
State Lie. #: 3&.51,0 0
City Lic. #.-
Arch., Engr., Designer: ���.S R. c9,6 L
Address:
City., ST, Zip:
{..iii:{8': •�4:•.tir..�:h:�:C:Gi±i;'<:? •.
Telephone:
P ; {}iz::;;!;:;;;•;;:::<::; ::>.•>ri:•>:.{{i
�sii,•S%`':::Ji:i{v:{?{}: iiiiY i:! i:v '}??
State Lie. #: ::, ;r»::>:::<:<::::>::<:>i::;:> {.;.:.i:.ii:.,..
..;;�.;�.;?•i:•;is.;;;.:�;;>;i:>:r�::::<�si;;.
Construction Type: Occupancy.
Project type (circle one): New , Add'n Alter Repair Demo
Name of Contact Person:.
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: '2 G
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets _
Plan Check submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
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
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:-
'rd Revlew,.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
1
7
Total Permit Fees
CITY- OF LA QUINTA SUBL-CONTRAeT?R ST
JOB ADDRESS9'� `D (� PERMIT NUMBER OWNER BUILDER
This form shall be posted on the job with the Building Inspection Card at all times hi a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the Voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
'kation
Trade ! Classif
Contractor :::: :::::::::::>
:;'::><:>::`::<>:':::;::S a :- tracto .s Ucensa :: ;; :-:;..:.::> :...;. :.;.;Sa.'>•:::,..t.:;S.:..: ; : ;:<
;:
t t.Con f :.: :,..:;;:. ... :.Vygrkeis.Co �n tlon..n. urance::: :.::..: ;>::;`•..:.<:; .::
:::
:..Cit . Bus
y eels License:;:;.:::
Company Name
Classification
(e.g. A, B, G-8)
License Number
(xxxxxx)
Exp. Date
lux/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
Exp, Date
(xx x/xx)
EARTHWORK (C-12)
Al (//q �2 ('
G l ()
�v l �s�
�l
(� d' l�?/L
�N OZ 2(0
/�(xxxx)
1 ���
CONCRETE (C-8) %
J �-Z C V�r�.R-� �-c
C- �
� j 3 Z& 1
3 3/1
/�c c v.S / rvs
of D1� � 2vvl
G�
6 2
� 3o a
FRAMING :4C-5)
STRUC7::'STEEL (C-51)
C (f !
C 8
�Z 2.� �c
�a 3�
�� f' (L 1 /US
c Z oo G o ( Z o `�
/ b Q
2 Z S
v l
-
PLUMBING (C-361
L q Q VV A C
— 3
!� V U
�'! 3UB
�D G cl /IIS
c L
�3[/
®p
2-- -Z
LATH, PLASTER (C=35)
DRYWALL (C-9) ,...:
HVAC: te-20r.:.:::`<`......
'ELECT CA (C=10) =. ,.:
C € (� W �� 1�
- 8
o
�i �v v�'l l .
/
l ( 3 0l4
/1!-C) I?- Uyl- R T,
ROOFING` >
.001t
00I
SHEET-METAL (643)
FLOORING
GLAZING (C-17);.
INSULATION,(-c.-21.
SEWAGE DISK Id-42) .
PAINTING (C=33)
CERAMIC TILE (C-54)
CABINETS IC-6)
FENCING (C1713)
LANDSCAPING ICG24.
POOL (C-53)
[ O f'v � y �J�
. 5
c7 !o
f
$/ %
I %
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4d 5 U- 3 ' .V L'l /
/
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