04-6275 (RPL)BUILDING & SAFETY DEPARTMENT.
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
1A QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153:
BUILDING PERMIT
Application Number
04-00006275
Date 9/10/04
Property Address . .
. . . 81706 SUN CACTUS_LN
APN:
Application description
764-270-999-56 -30'2\31-
. . . POOL - RESIDENTIAL
/1
U !n1
Property Zoning .
. . . . MEDIUM HIGH DENSITY
RES
Application valuation
15000
PrP 1 3 2004
a�
G
Owner
Contractor
CITY OF LA QUINTA
------------------ - - -
- --
__FIWAP_I4=�gPT
DOROTHY CAMPBELL
BLUE HAVEN POOLS
2318 ;S*. VINEYARD AVENUE (A):
81706_SUN CACTUS LANE
ONTARIO
CA 91761;
LA QUINTA
CA 92253
WCC: SPIEGLER.
WC: 07KR0000891 03/10/05
CSLB: 618892 05/31/05
CCC: C5.3
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Permit
MECH POOL
Additional desc
Permit Fee
24.00 Plan Check
Fee 6.00
Issue Date
Valuation
. . . . 0
Qty Unit Charge.
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA ' MECH FURNACE <=100K
9.00
Permit . . . . . .
BLDG POOL PERMIT
Additional desc
Permit Fee
162.00, Plan Check
Fee 105.30
Issue Date
Valuation
15000
Qty Unit Charge
Per
Extension
.BASE FEE
45.00
13.00 9.0000
THOU BLDG 2.,001-25,000
117.00
Permit . . . . . .
ELEC POOL PERMIT=RES,
Additional desc
Permit Fee . . .
45.00 Plan -Check
Fee 11.25.
Issue Date . .
Valuation
. . 0
Qty Unit Charge.
Per
Extension
BASE FEE
15.00
P.O. Box 1504 • �� VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT /
Application Number:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or
Lic. No.:
BUILDING PERMIT DECLARATIONS
Date:
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 Lice pe is �yl orce and effect. 9
License Class ; License No.
Date — Contractor
6111, 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 Secfion 7031.5 by any applicant for a 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. , B.& 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.
_ 1 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 w c rs' c mpensation insurance carrier an gJr��r}�re
Carrier r11 I Policy Number tN Y<6N? � 11
_ 1 certify that, m the performance of the work for which thi�pernit is issued, I shall not e� 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.
Dat "V (`
Applicant
WARNING: FAILURE TO SECURE WORKERS' MPENSATION 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
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 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 bove-mentioned property for inspection purposes.
Date — v7" Signature (Applicant or Agent):
Page .2
Application Number .
. . . . 04-00006275
Date 9/10/04
Qty Unit Charge
Per
Extension
f 1.00 30.0000
EA ELEC PRIVATE SWIMMING POOL
30.00
Permit . . . . . .
PLUMBING
Additional desc
1
Permit Fee
27.00 Plan Check Fee
5.25.
Issue Date . .
Valuation
0
Qty ..Unit Charge
Per
Extension
V
BASE FEE
15'.,00
1.00 6.0000.
EA PLB FIXTURE
6.100
.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
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Special Notes and Comments
POOL ONLY. ALARMS BARRIERS
SHALL
BE IN PLACE PRIOR TO
PREPLASTER
INSPECTION. EQUIPMENT.ENCLOSURE
NOT
INCLUDED IN PERMIT.
Fee summary Charged
Paid Credited
Due
Permit Fee Total
258.00 .00 00
258.00
Plan Check Total
127.80 .00 .00
127.80
Grand Total
385..80 .00 .00
385.80
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NO WiSAL AMEME +TS OWN SHALLOW
APPLY S� WrT END
NOT TO SCALE
The Most Dependable
Custom Pool Builder in
Southern California
Since 1954.
RUSTOM DESIGN FOR:
NAME: +� O 1 C� 'vr
ADDRESS: 1- o(.
L
CITY. v T
HOME TELEPHONE S: —7G0-? $SGL OFFICES:
LOT: TRACT.
APNe
MAP BOOK PAGE
CROSS STREET:
SPECIFICATIONS
TYPE: t �AcJi�'�1 SIZE:
SURFACE AREA POOL: t
r
PERIMETER: DEPTHS: MIN. - 3 ! MAX. S
VA SPECIFICATIONS:
EUKTRICAL: ,
S2E:
8`F
DAM WALL WIDTH
TIME CLOCK: SUB PANEL
ND.OF JETS:
Lon IN POOL SPA
SPILLWAY(S): SIZE
POOL PUMP: > SPA BLOWER
SOWER HP
WATERFEAT M PIMP:
BOOSTER PUS HP
SPM BOOSTER
FREE STANDING SFtt - r: 1 r
STUBS'
tr 24'
MISC:
MIK.
gtI"
ROPE RINGS: ORM RAILS:
S' R.e.e. it R B.B. Ir A.B.B.
2A'R.e.6. 3 RBB
EXCAVATION:
LOVMEAT: MENDED 2vd STEPS:
TYPE:
NOTCH RAISED SOLD SEAM
DEEP END RUMP:
BPA DMI WALL WIDTH:
FENCE REMOVED BY:
NO CH SPA DAM WALL:
r R.B.B. Ir RBB. Ir R.S.S.—M
rA
24-R.S.S. Sb' R.B.B.
TRASH REMOVAL (LOAM:
CaNc;FRETE REMOVAL (LOADS):
TREE REMOVAL BY:
M. NMrTE: BULLNOSE BRK:K:
STUMP REMOVAL BY.,
F1 GSTONE: OMER
TLE GRDl1P: ` tLE TR�k
STEEL
Mtn:
r R.S.B Ir RI.S. tr R.B B.
24' RBB 3n' R.B.B.
oI cKNo .
SURCHARGE:
LovESEAT INSDe BvaMouT
Br UP TO SO. FT.
SPA WALL WIOTR
FM+ COLOR
ux.
STEPS:-
CANTILEVER:
MASTIC: CURB COW-
INUMINO
DECCO DRAINS:
FILTER SIZE:
AREA DRAINS:
POOL PUMP: HP sa
PNTIO FOOTING SIZE:
HEATER: STIh
SPA BOOSTER PUMP. HP
PLASTER:
WATERFEATURE PLANP: HP
SAW OR: P•Tw.
BTANONRD -
GAS LINE: STUBS
SMART SPITE
SHEER DESCENTSI RAN:
OTHER
LKINTS IN POOL. IN SPA:
SPECIAL EOUPMENT:
MISC.
DELUXE MAINT IUT:
POOL COVER .
DIVING BOARD-
OARDSIDE.
SLIDE.
SMARiVAC:
OTHER
OWNER RESPONSIBILITIES
OWNER TO: (I) Deternwne the approxwele atSvation of pod or We at Yyout on day Of a,reauaUon.
(2) Take notice Viet pod and equipment bcabon is subject to acceptance of beat txradktg
department at lime of issuance of permit.
(3) Wet down concrete thea at bast twig daily to Wren (7) days after sttee is Walled.
(4) Take notice mat BLUE HAVEN POOLS tS NOT RESPONSIBLE br: underground condift .
or objects, and any damage Io webs, sidewaks, drirCways, lawns or other Its.IM in ecoess area.
(S) See that as lanefng, gates, and garage dons meet beat codes to a pod enclosure prior to
pro-pte sster wtspection.
(6) Fin pod inwnedmlety after plaster. (Follow irWruetiats do not use rubber hose)
(7) NO VERBAL AGREEMENTS APPLY.
(B) Fencing to meet all local code requirements by buyer prior to pre -plaster inspection.,
Owner approves plan, pod. equipment locations and understands dedit M for 7ustrXIM ONLY.
Owner understands they are to reeeNe sq- ft. of ded o g per Wntract.
Signed: Dare' - -