04-6972 (RPL)W-1
�117A116t: Utr'r. I I iJGrAR I mG/`/ I
P.O. Box 1504
(760).777-7012
+
C��1pF9ti' `78-495 CALLS TAMPICO r` ' `' `' FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS
(760) 777-7153
BUILDING PERMIT
AppliFation Number . . .04-.00006972_
Date 10/27/04
Proper'Gy Address 52030 AVENIDA VILLA
APN: 773-234-001-22 -000000-
Applicat'ion description . . . POOL - RESIDENTIAL.
t
Property Zoning . . . . . . COVE RESIDENTIAL
Application valuation . . . . 17000
Owner Contractor
SMITH SETH B BLUE HAVEN POOLS
-030 Q�r �,.(.,QQ��
NOT.Se? 2318 S. VINEYARD
AVENUE
CA g 9 ONTARIO
CA, %91.7,6-
76425.3
•
q;2253
- t
WCC: SPIEGLER
WC: 07KR0000891
03/10/05
CSLB:' 618892'
05/31/05 ;
CCC: C53
--------------------------------------------------------------
:.
--------------
Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Fee . . . . 180.00 Plan Check Fee
,. 117.00
Issue Date . . . . Valuation
16827
Qty Unit Charge Per
Extension
BASE FEE
45.00
15.00 9.0000'THOU BLDG 2,001-25,000
----------------------------------------------------
135.00 ;
-------------.------.-----
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 . . . . . . ELEC POOL PERMIT -RES
Additional desc - ti
Permit Fee . . . . 45.00 Plan Check Fee
1.1.25
Issue Date Valuation . .
. . 0
Qty, Unit'Charge', Per
Extension
BASE FEE
15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL
30.00
Permit PLUMBING
t
Additional desc ■
,-
Permit Fee . . . . 33.00 Plan Check Fee
.'8.25
C&lf 4
P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
VOICE (760) 777-7012
FAX (,760) 777-7011
INSPECTIONS (760) 777-7153
Application Number: % Date: /D
Applicant: I Architect or Engineer:
Appncanrs Mailing Address: -W--1
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
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.
License Class r --5I Ligense No. 618892
-z9-Oy
I herebyaffirm under U OWNER -BUILDER DECLARAW
penalty of perjury that I am exempt from the Contractors' State License Law foF{he 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 ofjAe 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 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. , BA P.C. for this reason
Date Owner
I hereby affirm under penalty of perjury one of the following dec a attiiionsRS' COMPENSATION DECLARATION
_ 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 �p�L�oLcy�purober re:
Carrier Clarendon National Policy Number b%9600Mrf
_ 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, j>; I should become subjecS to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall
sions.
forthwith comply with those provi�/ !
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COEFEE
GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS.
I herebyaffirm under CONSTRUCTION LENDING AGENCY
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.).
01
Lender's Name
Lender's Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
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 Ouinta, 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 agree to comply with I city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter upon thea ve mention grope r inspection purposes.
ate —��ignatur.pplicant or Agent):
Page 2
Application Number 04-00006972
Date 10/27/04
Issue Date . ." . . Valuation
0
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
3.0.0
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS,
.3.00
Permit . . . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . 15.00 Plan.Check Fee
00
Issue Date . . . . Valuation
173
Qty Unit Charge Per
Extension
BASE' FEE
15.00
Special Notes and.Comments
POOL/SPA, 8 L.F. 51.BLOCK WALL, CITY
STANDARD,.GFI & GAS,STUB FOR FUTURE BBQ.
ALARMS/BARRIERS SHALL BE.IN PLACE,AT
PRE -PLASTER INSPECTION. EQUIPMENT
ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited
Due
. Permit Fee Total 297.00. 00 00
297.00
Plan Check Total 142..50 00 ..00
142.50
Grand Total 439.50 .00 .00
43.9.50
III
i �rThe Most Dependable
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Custom Pool Builder in
"} Southern California
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Since 1954.
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- = CUSTOM DESIGN FOR:
NAME:_ _S �- i
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WRESS. Sc�-3 U,6 / 11,q
Cm: /4 s// A,, 7414
HOME TELEPHONE r OFFICE#: S Z -eg -Z 217
LOT: TRACT:
ARNO
MAP BOOK PAGE
CROSS STREET:
SPECIFICATIONS
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TYPE: SIZE:_x
SURFACE AREA POOL. 3y
Y
PERIMETER: 3 DEPTHS: MIN.�•�_MA%.
SPA SPECIFICATIONS r
SU 7y/.41►'�
ELECTRICAL:
By �f?
TW CLOCK: SUB PANEL-.
DAM WALL WIDTH: 12
NO. OF JETS S
LIGHTS IN POOL- f SPA
JJ
SPUWAY(S): / s7c � ,�
/7
POOL PUMP: SPA @LOWER, '
BLOWER: 11P
WATERFEATURE PUMP:
BOOSTER PUMP: INP - .
SAA BOOSTER:
FREE STANDING SPA - ft': 12*
�
STUBS:
MISC
is. Yi� 5 2r
MISE
GUWTE
ROPE RIGS: GRAS RAN.S-
IrRB.S. 12'RBB. - 1rR8B.
24'R.S1. - 30' R.8 B.
EXCAVATION
LOVESEAT: EXTENDED 2nd STEPS:
TYPE
NOTCH RAISED BOND SEAM
DEEP END RAMP: 1iI�
SPA DAM WALL WIDTH:
FENCE REMOVED BY d wvE /
NOTCH SPA DAM WALL
rX.8,8. -Ir A.B.B. IrA.BB.
mW,
20A.9 B. 3D' R.B B.
TRASH REMOVAL (LOADS)'
CONCERE?E REMOVv AL (LOADS) : /
TREE REMOVAL BY:
T ILE L CCPING: II
STD. WHITE -BULLNOSE BRICK:
t
STUMP REMOVAL eY:
FLAGSTONE: OTHER.
T0.E GROUP: - TILE TRIM '
$ILEMtSCI:
,
r R.B.B. Ir Rea. Ir R.8 8
2r R.B.B. 30' R.B.B.
DECI(a1G C
11PT0: ( �' SO F,
FINISH: COLOR:
SURCHARGE
LOVESEATNSOE: ! SwImOff
SPA WALL WIDTH:f Z I
STEPS:
CANTILEVER: .�
MASTIC: CURB CORE:
PLUMBING
FUER /�! I BI �p
POOL PUMP Z HP: Z SO
DECCO DRAM:'
AREA DRAMS:
HEATER: Bc �✓ 60
PATIO FOOTING SQL:
SPA BOOSTER PUMP: w.
PLASTER
VICERFEATUREPUMP: „ HP
SAW CLP: P -TRAY:
ST WDARD-
_
SMART BWM: �/ E
GAS IJNE: 70 Y STUBS:
SHEER DESCO:TSI RAIN.
r
OTHER.
.
LIGHTS N POOL / IN $PA. a/
SPECIAL EOUIPMENT:
MISC.
DELUXE MAI NT KP:
POOL COVER
DNNG BOARD:
SLIDE:
SMAR W-.
OTHER is 1
Ay /e) 11-61—
61—OWNER
'OWNER RESPONSIBILITIES
OWNER TO- (1) Determine the nlppmornate elevation of pool or We of leyolA on day of excavation. j
(2) Take notice Mat'poof and eiWorent location is subject to acceptance of local building
departRYent at time of Issuance of pernvt.
(3) Wet down concrete then at least twice daily lot seven (T) days after Shen is installed.
(4) Take slice that BLUE HAVEN POOLS IS NOT RESPONSIBLE for: underground conditions
or objects, and any damage to curbs, sidewalks, dmeways, fawns or other items in access area.
(S) See that at forcing, gates, and garage doors meet local codes for a pod enclosure prior to
pre -plaster inspection.
(6) Fit pool Wmmedately after pfaster. (Follow instructions, do not use rubber hose) p
(7) NO VERBAL AGREEMENTS APPLY. I
(B) Fencing to meel all local Code requae ner95 by buyer prior t0 pre -plaster inspection.
Owner approves plan, pool, equipment Iodations and understands decking Is for Illustration ONLY.
Owner understands they aro to receive tq, ft of decking per contract.
Signed: -- -Date: