11-0832 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T,i`(t 4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
11-00000832 '
Property Address:.
54315 AVENIDA VALLEJO
APN:
774-244-033-3 -000000-
Application description:
POOL - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
. 19000
ApplipApt: 1/, . /Y/ Architect or Engineer:
US1
--------------------------------------------------
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.
LicenseClass: C53 -C27 LicenseNo.: 823017
Date: Contractor: v -
OWNER -BUILDER CLARATION
kr
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.): '
(_ 1 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.).
(_ 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:
BURGOSE ED
54315 AVENIDA VALLEJO
LA QUINTA, CA 92253
Contractor: reJ f
MCRAE POOL & SPASM"
79105 DESERT STREAM DR
LA QUINTA, CA 92253
(760)774-6343
Lic. No.: 823017
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/02/11
s jrG 08
tr�_9Uc�
1 L
C)'fY(.eLA Ulti-iA
----------------------------------------------—
WORKER'S COMPENSATION DECLARATION
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 1950505
_ 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
370000 of the Labor Code, I forthwith comply with those provisions.
iDate __ 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 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 thiscounty to ant upon the above-mentioned property for inspectioy.gyrposes. -
a rr/
Dat>t' �' Signature (Applicant or Agent):
Application Number .
. . . 11-00000832
Permit
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
198.00 Plan Check
Fee
128.70'
Issue Date . . . .
Valuation
19000
Expiration Date
.1/29/12
Qty Unit Charge
Per..
Extension
•'
BASE FEE
45.00
17.00. 9.0000
-----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
153.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
24.00 Plan Check
Fee
6.00
Issue Date.
Valuation
0
Expiration Date
1/29/12
Qty. Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
----------------------------------------------------------------------------
EA . MECH FURNACE <=100K
- 9.00
Permit . . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee
15.00 Plan Check
Fee
3.75
Issue Date . .
Valuation
0
Expiration Date
1/29/12
Qty Unit Charge
Pet
Extension
----------------------------------------------------------------------------
BASE FEE
15.00
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . .
33.00 Plan Check
Fee
8.25
Issue_Date'". . . .
Valuation
0
Expiration Date
1/29/12
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
PLACE AT PRE PLASTER
INSPECTION
LQPERMIT
Application Number
. . . . .
. 11-00000832
--------------------------------------------------------
Special Notes and Comments
-
EQUIPMENT ENCLOSURE
NOT INCLUDED
2010
CODES.
--------------------------------------------------------
Other Fees . . . .
... . .
--------------------
BLDG STDS ADMIN (.SB1473)
1.00_
Fee summary
Charged
Paid
Credited
Due
-----------------
Permit Fee Total
-----
27.0.00
----
.00
---------- -----
.00
270..00
Plan Check Total
146.70
.00
.00
146.70
Other Fee Total
1.00
.00
.00
1.00
Grand Total
417.7.0
.00
.00
417.70
LQPERMIT
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
X63
Project Address: S 3 )
U
Owner's Name: 0
Address: 5 Y— 315 nyE UA 1- LED
0
A. P. Number:
Legal Description:
City, ST, ZipjA qy,t .l 3'
�k:�:vJ�,J..:SR
Telephone: £:X >>
Contractor:
Address: —
J
Project Description: S'
City, ST, Zip: C)114
922,TJ
Telephone: %
SV.t:??4. Vii: ?.JJ�.;• 'v}C.".
H. i : : •.. n Via? :.?.v..::: Val.J
; c,<�s. 4:":J:"".• �En.x rk..:.::;,s:>s:
F'F'�r<tt4 tiii.G:t"�Y.jJJ.v: ::F :?.. •:: v..i:: ::::t
City Lic. #; V
State Lic. # : 2 30 I
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone::•.
a "`�`: `<. s
��;' � .� �
qq`
;" • <_ fJ _;. ;µ: � ftS
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair
Demo
Name of Contact Person:
C
Sq. Ft :#
Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
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:-
''' Review, ready for correctionstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
INSTALLATION CERTIFICATE CF-6R-MECH-03
Pool And Spa Heating Systems (Page 1 of 2
Site Address: Enforcement Agency: Permit Numb r
Pool and Spa Heating Systems requirements
§114(a ystems and Equipment.
l�Heater has a thermal efficiency that complies with the Appliance Efficiency Regulations.
as a readily accessible on-off switch mounted outside of the heater.
Weatherproof plate or card containing operating instructions for the pool or spa heater.
4. No electric resistance heating except for listed package units that has fully insulated enclosures and tight fitting
covers that are insulated to at least R-6. Or if documentation is provided that at least 60 % of the annual heating
_ 'energy is from site solar energy or recovered energy.
LTJ 5, Heating system has no pilot light.
§114(b • "stallation.
1. S. System is installed with at least 36" of pipe between the filter and heater, or dedicated suction and return lines,
r built-in or built-up connections for future solar heating..•
Fool
Acover for outdoor pools or spas that have a heat pump or gas heater.
system has directional inlets to adequately mix the pool water
Cd" 4. Time switch which will allow the pump to be set or programmed to run during off-peak periods only
§150(p) Pump Sizing and flow rate specification
Del The pump specified is listed in the CEC database of certified pool pumps:
Er'T The pump flow rate shall be calculated based on pool sizingtable below.
m-3. Tie pump is capable of operating at 2 or more speeds (not applicable if pump is less;than 1 horsepower).
❑ Each auxiliary pool load is served by either a separate pump, or the system is served by'a multi -speed pump.
Pool slzlna (VninpS S1rP hacPri nno movimum o11n...o1Jo t..........e...... �.. ..i[ t.........\
Max Pool
.Volume
(gallons)
Min Pipe Dor Greater
inches)
Min Filter Area or more
(sqare feet
Max Pump
Flow m
Return
Suction
Cartridge Sand
DE
l3 0
1.5
1.5
100 2.4
20
36
17,000
1.5
2
130 3.1
25
47
>
1% 3.9
30
58
28,00
2
2.5
210' 5.2
40
78
42,000;-
2.5
3
3207.8
60
117
48,000
3
3
360 8.9
70
133'
r4oie: ror pumps greater than t hp. .I he maximum Pump Flow is the lowest speed default filtration
❑ 5. Calculated volume of.pool 0 (gallons).
❑ 6. Return Pipe Diameter % (inches).
❑ 7. Suction Pipe Diameter f-/' (inches).
❑ 8. Filter Type rAJ046 (C( I- ZOCartridge', Sand, DE).
❑. 9: Filter Surface Area c3 (SO.
❑ 10. Max Pump Flow (gpm).
.� V
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-611-MECH-03
Pool And Spa Heating Systems (Page 2. of 2
Site Address: Enforcement Agency: Permit Number:
-315 vE 1l-7
Sy7'The
Piping
❑ suction side pipe is straight for at least 4 pipe diameters before entering the pump (See table below for the
required straight run lengths for various pipe sizes).
t"'2. The design uses low pressure drop fittings (sweep90's)
Pipe Diameter
inch
Required Pipe Length
leading into pump (inch)
1
6
2
8
5
10
3
12 .
Filtration Equipment
lig 1. I -backwash valve is used: The diameter of the backwash multi -port valve'is 2 inches or as large as the
/ ` circulation pipe, whichever is greater
DE,QURATION STATEMENT
1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
_---rcertify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
reviewed a copy of the Certificate of Compliance (CF -I R) form approved by the enforcement agency that identifies the specific
re
quirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building
permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. 1 understand
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to
the building owner at occupancy.
Company Nae: (Installing Subcontractor or General Contractor or Builder/Owner)
X2.4 r S
2008
Res 'ble Person's Name:
M/{4 Cil .4
Responsible Person's Signature
CSLB License:
UO
7Date�_Sii�ed:
Position With Company ( it e
Residential Compliance Forms August 2009
z
DRAWN
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GATE
SCALE
JOB NO.
SHEET
OF SHEETS
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