13-0179 (RPL)1 P.O. I rOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000179
Property Address: 80615 VIA PORTOFINO
APN: 777-150-025- - -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Applioation valuations 21500
Applicant:
Tiht4)4Q"
BUILDING & SAFETY DEPARTMENT
Architect or Engineer:
BUILDING PERMIT
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 cofessionals Code, and my License is in full force and effect.
License Class: C53 License No.: 802919
Date: -?-,1.5')2Y Contractor:
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).:
(_ 1 1, 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 _ 1 1, 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.).
(_ 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:
DONOFRIO
80615 VIA PORTOFINO
LA QUINTA, CA 92253
Contractor:
AZURE POOLS AND SPAS
P.O. BOX 10641
PALM DESERT, CA 92255
(760)322-7665
LiC. No.: 802919
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/22/13
U
,.Tv O i L4 pFPNTA
WORKER'S COMPENSATION DECLARATION
I hereby ,anffirm 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 SOUTHERN INS Policy Number PWC002199-12
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
3700 of the Labor Code, I he I forthwith comply with those provisions.
Dat c!� 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 this county to enter upon the above-mentioned property forection purposes.
�Dat S/ ignature (Applicant or Agent)
Application Number . . . . . 13-00000179
Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 8/21/13
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 . . . . 225.00 Plan Check Fee 146.25
Issue Date . . . . Valuation . . . . 21500
Expiration Date 8/21/13
Qty Unit Charge Per Extension
BASE FEE 45.00
20.00 9.0000 THOU BLDG 2,001-25,000 180.00
----------------------------------------------------------------------------
Permit ELEC POOL PERMIT -RES
Additional desc . .
Permit Fee . . . . 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation . . . . 0
Expiration Date 8/21/13
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 . . 8/21/13
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
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL POOL/SPA IN REAR OF HOUSE AND
POOL EQUIPMENT ON SIDE OF HOUSE. INSTALL
LQPERMIT
Application Number . . . . . 13-00000179
-----------------------------------------------------------------------------
Special Notes and
Comments
4 FIRE BOWLS ON BACK OF POOL AND FIRE
PIT. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . .
BLDG STDS
ADMIN (SB1473)
1.00
Fee summary
Charged
----------
Paid
----------
Credited
--------------------
Due
-----------------
Permit Fee Total
320.00
.00
.00
320.00
Plan Check Total
170.00
.00
.00
170.00
Other Fee Total
1.00
.00
.00
1.00
Grand Total
491.00
.00
.00
491:00
LQPERMIT
Bin # Clay of La Quanta
Building 8L Safety Division
Permit # P.O. Box 1504,-78-495 Calle Tampico
ta.Quinta, CA 92253 - (760) 777-7012
I I
.
Building Permit Application and Tracking Sheet
Project Address: /S / PGOZ O/- i w C Owner's Name:. -c—
A P. Number. Address: .� l IAa
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j Legal Description: City, ST, Zip:
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Contractor: .S
Telephone:
Address: U c �j(p / .
Project Description:
City, ST, Zip: w`y .'{a
COOL P v, 0
Telephon
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State Lic. # : Got �/% r -S City Lie. #.-
S S 4 J
—4
Arch, Engr, Designer. OV
Address:
City, ST, Zip:
Telephone: Construction Type: " Occupancy:
State Lic. M ,Cf wgjsCy r Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. FL: #Stories: # Units:
Telephone # of Contact Person: . '�ZL,• �� �r 2,1.
Estimated Value of Project i
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Rec'd TRACKING PERMIT FEES"
Plan Sets Plan Check submitted Item Amount
Stractuiai Cafes Reviewed, ready for corrections Pian Check Deposit.Truss .
C21cs• Called Contact Person Plan Check Balance -
Title 24 Calci. Pians picked up Construction
--Rood plain plan _ . — -- _ Maas -resubmitted ": - - — _.. --Mechanical—
Grading plan 2'i Review, ready for correctionstiissue Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
''' Review; ready for corrections issue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
171
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