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12-1027 (RPL)r P.O. BOX 1504 T-il4t 4 �IGGII�Iii(/ 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT i Application Number: 12-00001027 Owner: Property Address: 78271 DEACON DR W PACIFIC KELLY APN: 770-210-036- - - 78271 DEACON DRIVE WEST Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL ( D Application valuation: 27000 Contractor: Applicant: Architect or ineer: SUNAIR POOLS 72794 RANCHO GRANDE PALM DESERT, CA 92260 (760)568-4014 Lic. No.: 397252 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busin d rofes 'onals Code, and my License is in full force and effect. License Class: C53 Li nse No.: 397252 Date_ ` • �L Z— Contractor• -IV IIli OWNER-BUILDERTION I hereby affirm under penalty of perjury that I am exempt from the C ractor'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 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 contractor(s) licensed pursuant to the Contractors' State License Law.). (_ 1 I am exempt under Sec. , BAP.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 VOICE (760) 777- FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/13/12 u cFp 18 2012 CITY OF LA QUINTA FINANCF, DEPT. WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ 1 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 0517316 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 sh eco subject to y4e wo rs' compensation provisions of Section Q 3700 of the labor de, sh forthwith c �iply h those provisions. Date. � � V �ZApplicant• WARNING: FAILURE TO SE RE WORKERS' COMPENSATION OVER E IS NLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TQXNE 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. certify that 1 have read this application and state tha a ab ve' formationcorrect. I agree to comply with all city and county ordinances and state laws relating buildi c structio , d by authorize representatives of this county to enter upon the above-mentione rope inspect r S. 'Date:!• ��3lgnaturelApplicanior e r Application Number . . . . . 12-00001027 Permit . . . MECH POOL Additional desc . . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/12/13 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 . . 265.00 Plan Check Fee 172.25 Issue Date . . . . Valuation . . . . 27000 Expiration Date 3/12/13 Qty Unit Charge Per Extension BASE FEE 252.00 2.00 6.5000 THOU BLDG 25,001-50,000 13.00 ---------------------------------------------------------------------------- Permit . . ELEC POOL PERMIT -RES Additional desc . Permit Fee 45.00 Plan Check Fee 11.25 Issue Date . . . . Valuation 0 Expiration Date 3/12/13 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 . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/12/13 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 6.0000 EA PLB FIXTURE 12.00 s 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 / BARRIERSSHALL BE IN LQPERMIT Application Number . . . . . 12-00001027 ---------------------------------------------------------------------------- Special Notes and Comments PLACE AT PRE PLASTER INSPECTION. EQUIPMENT ENCLOSER NOT INCLUDED .2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary ----------------- Charged Paid Credited Due Permit Fee Total -------------------- 369.00 .00 -------------------- .00 369.00 Plan Check Total 198.25 .00 .00 198.25 Other Fee Total 1.00 .00 .00 1.00 Grand Total 568.25 .00 .00 568.25 LQPERMIT Bin.# City of U Quints Wdt y & Safety Div[sion P.O. Box 1504,•78-495 Calle Tampico La.Quinfa, CA 92253.:(760) 777-7012 Building Pennit-Applicadon and Tracking Sheet permit # Project Address: 7�- 7� W Owner's Name:. L A. P. Nurnber. ,j Address: 79-2 71 Legal Description: City, ST, Zip: k- r 641 Contractor. �) ti A%{ Address:7.2 —,7 q /1�4-ti44s �O M-AAjo— b Project Description: l? t 'j p-� 1N City. ST, Zip `Yl C'1 LZ 6 L 7. Telephone: 7&o- &vState StateLic. #: C ;3 7 L 2 City Lie. C Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lia #: Name of Contact Person: Construction T . ypc6 0A1 L Occupancy: Project type (circle one): cw Add'n Alter Repair Demo Sq. Ft.: # Stories:# Units: Telephone # of Contact Person: Estimated Value of Project: 2--7 �• D U 4. APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rted TRACKING PERMIT FEES - Plan Sets Plan Check submitted Item Amount Structural Calls. Reviewed, ready for corrections Plan Check Deposit. . Truss Cala. Called Contact Person Plan Cheek Balance. Title 24 Calci. Plans picked up Construction Flood plain plan Plans resubmitted Mechaiiicsl Grading plan 2'! Review, ready for correctionshssue Electrical Subcontactor List Called Coatact Person Plumbing Grant Deed Plans picked up S M L H.O.A. Approval Plans resubmitted Grading I14 HOUSE:- ''• 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