12-1375 (RPL)P.O-BOX 1504 ^�� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
- Date: 11/21/12
Application. Number: 12-00001375 Owner:
Property Address: 80350 VIA CAPRI DORWARD, DAVID & JANICE
APN: 772-440-076- - - 80350 VIA CAPRI
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 38000
Contractor:
Applicant: Architect or Engineer:PNO
VACATION POOLS INC
PO BOX 10940
INDIO, CA 92202
20(760)775-0468
012 LiC. No.: 856835
CENSER �N RACTOR'S DECLARATION
I hereby affirm under penalty of perjury, a I am en under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the 8u ' es an rof . nals Code, and my License is in full force and effect.
Licensg Class: C53 License No.: 856835
i♦1 i -JP /4 ,. - M.
V 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.).
(_) 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:
LQPERAIIT
--------------- - - -
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 FUNDAbeme
Po I' yNumber 1948584-2012
I certify that, in tof a ork or which this permit is issued, I shall not employ any
person in any eco e s ject to the workers' compensation laws of California,
and agree thatme ubj t to the workers' compensation provisions of Section
3700 of the Lll rth h comply with those provisions.
Date:V ApplicanWARNING: FAILURE TO SEC' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND,,-
DOLLARS
HOUSAND/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 eildco
ove i rm tion is correct. I agree to comply with all
city and county ordinances and state laws relating to btruc 'on, and hereby authorize representatives
of this o my to enter upon the above-mentioned propr ' spa on purposes.
%i
Date: / p "Signature (Applicant or Agent
Application Number . . . . . 12-00001375
Permit. . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . . 336.50 Plan Check Fee 218.73
Issue Date Valuation . . . . 38000
Expiration Date 5/20/13
Qty Unit Charge Per Extension
BASE FEE 252.00
13.00 6.5000. THOU BLDG 25,001-50,000 84.50
----------------------------------------------------------------------------
Permit . . . ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation . . . . 0
Expiration Date 5/20/13
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 . . . . 24.00 Plan Check Fee 6:00
Issue Date Valuation . . . . 0
Expiration Date 5/20/13
Qty "Unit Charge Per Extension
BASE FEE 15 '.00
1.00 6.0000 EA PLB FIXTURE 6.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00
----------------------------------------------------------------------------
Permit MECH POOL
Additional desc .
Permit Fee . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date . 5/20/13
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE >100K 11.00
----------------------------------------------------------------------------
Special Notes 'and Comments
POOL AND SPA AT REAR YARD ONLY [1-1/4
INCH GAS PIPE FOR HEATER ONLY] THIS
LQPERMIT
Application Number. . . 12-00001375
-----------------------------------------------
Special Notes and Comments
--------------
---------------
PERMIT DOES NOT INCLUDE EQUIPMENT WALL.,
FIRE PITS, OR WATER FEATURES. ALARMS AND
BARRIERS REQUIRED TO BE INSTALLED AT
PRE -PLASTER INSPECTION. 2010 CALIFORNIA
BUILDING CODE.
November 21, 2012 1:15:33 PM AORTEGA
Fee summary Charged Paid
-------------=------
Credited
--------------------
Due
-----------------
Permit Fee Total 431.50 .00
.00
431.50
Plan Check Total 242.48 .00
.00
242.48
Grand Total 673.98 00
.00
673.98
LQPERMIT
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TO PROPERTY
551-211
TO PROPERT7
LE
II �
641_511
'ROPERTY LINE
sk _
NEW
FOUNTAIN 71 p
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VACATION POOLS, INC.
P.O. Box 10940
–� Indio, CA 92202
Ph. (760) 775-0468, Fax(760) 775-0469
License # C-53-856835
NOTE:
Landscape elements (Trees,
Shrubs, Vines and Lawn) and Patio
Furniture shown for illustration only.
Unless by separate bid.
CONTRACTOR cannot assume
responsibility for damage to curbs,
sidewalks, driveways, cement slabs,
sewers, lawns, trees, fences, retaining
walls, sprinklers, wires, valves,
telephone or shrubs.
When access is made through a
neighbor's property it is understood
that you, the owner, have that
neighbor's permission and assume full
responsibility.
DATE 51ONATURE
D
Scale: I/8"=1' -O"
HIDEAWAY LOT 62 4 63
80-350 VIA CAPRI
LA allINTA, CA Q2253
HIDEAWAY COUNTRY CLUB
APN 777-100-077
DATE: 11.21.12 1 . REV15ED:
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CA IN
VACATION POOLS, INC.
P.O. Box 10940
'a Indio, CA 92202
Ph. (760) 775-0468, Fax(760) 775-0469
License # C-53-856835
NOTE:
Landscape elements (Trees,
Shrubs, Vines and Lawn) and Patio
Furniture shown for illustration only.
Unless by separate bid.
CONTRACTOR cannot assume
responsibility for damage to curbs,
sidewalks, driveways, cement slabs,
f��DE�W�1� LOT 62 $ 63
_
80-350 VIA CAPRI
sewers, lawns, trees, fences, retaining
LA OUINTA, GA 82253
walls, sprinklers, wires, valves,
HIDEAWAY COUNTRY CLUB
telephone or shrubs.
APN 171-100-011
When access is made through a
neighbor's property it is understood
that you, the owner, have that
DATE: 11.21.12 REV15ED:
neighbor's permission and assume full
responsibility.
D
DATE 516NATURE
5co l e : 1"=20'-O"
B;R.#
City. ofla Quinta
Bu11&rlg & Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 • (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Im
Project Address: O jS�'
1,4
Owner's Name:. 1!
A. P. Number.
Address: .D I tJ1,114 04,6r
Legal Description:
City, ST, Zip.1-4 C/ ha;4
Contractor Qc 471' j o
n
Q (j GJ
p
Telephone: G
Address:L V bolt l
q.6
Project Description: Poo L cmdS
City, ST, Zip: ti /o
ad
p
Telephone: 76�-7
krisV tt i
State Lic. # :
City Lic..
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:Sq.
Y ` `�
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Ft.: #Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT., DO NOT WRITE BELOW THIS UNE
9
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted
Item
Amount
Strgctuial Cates.
Reviewed, ready for corrections
Plan Check Deposit_
.
Truss Cates.
Called Contact Person
Plan Check Balance -
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
r' Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
'^' Review, ready for corrections/mat
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees