08-0976 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: X06-00000976��
Property Address: 053075 .-VIA CHIANTE
APN: 772-550-010- - -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 22000
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm under penalty of perjury that I am lic used under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business an fessionals Code, and my License is in full force and effect.
LicensjCs: A LicenseNo.: 859859 -
te: ractor. '
OWNER -BUILDER DECLARATION -
I hereby affirm under penaltyof ry that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, siness 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 signedstatementthat 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.).
(_ I 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 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 '
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
ODate: 6/09/08
Owner:
BLAKE SCHWARTZ
53075 VIA CHI E
LA QUINTA., CA 92- 3
C%ry 0 7
Contractor: ��N�Nc�Q 100
FG D
HENRY'S ENGINEERING �FATTq
P.O. BOX 10290
INDIO, CA 92.202
(760)275-6956 f
LiC.. No.:.859859
i
WORKER'S COMPENSATION DECLARATION
I herebyaffirm 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 ' 236-000953
I certify that, in the performance of a work for which this permit is issued, I shall not employ any _
.person in any manner so as t ecome subject to the workers' compensation laws of California,
and agree that, if (should ome subject to the workers' compensation provisions of Section .
3,77000 of the Labor Cod hall forthwith comply with those provisions.
Zate: / �"U_ v plicant: '
WARNINAWURE TO SECLTRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN 6MPLOYER 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 per it, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that t a ve information is correct. I agree to comply with all
city and county ordinances and state laws relating to il, i g construction, and hereby authorize representatives
of this cou to enter upon the above-mentioned p for inspectio oses.-
Dat �� "�Signa t (Applicant or A n
LQPERMIT
Application Number
08-00000976
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee
225.00 Plan Check Fee
146.25
Issue Date . . .
Valuation
22000
Expiration Date
12/06/08
Qty Unit Charge
Per
Extension
BASE FEE
45.00
.20.00 9.0000
THOU BLDG 2,001-25,000
180.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date . . .
Valuation
0
Expiration Date
12/06/08'
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
EA MECH FURNACE >100K
11.00
Permit
ELEC'POOL PERMIT -RES
Additional desc ..
Permit Fee
45.00 Plan Check Fee
11.25
-
-Issue Date
Valuation . . .
. 0
Expiration Date
12/06/08
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
12/06/08
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
LQPERMIT
Application Number . . . . .. 08-00000976
------ ----------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
Fee summary Charged
Paid
Credited
Due
Permit Fee Total 329.00
.00
.00
329.00
Plan Check Total 17.2.25
.00
.00
172.25
Grand Total 501.25
.00
.00
501.25.
LQPERMIT
Bin #
City of La Quinta
Building 8E Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA•92253 - (760) 777-7012
Building Permit Application and Tracking Sheet •
Permit #
Project Address: -'3 d 7 ,S" vJ Ar- W A,,—�,'
Owner's Name: SG�w
A. P. Number: LA j,, V -,N— Z Z L4
Address:30.33,
Legal Description:
Contractor: Q
City, ST, Zip: A,�� g(
Telephone: 30�j 3 6
Address:
Project Description: aG G
City, ST, Zip: �N
c
Telephone:
State Lic. # : S S
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip: 11 l nom ScJ �J'�'
Telephone:
g r�
Construction Type: Occupancy:
State Lic. #: 3 3 Lt c..( L
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: � # Stories: #Units:
Name of Contact Person: 0 C—, qn G
Telephone # of Contact Person: S G
Estimated Value of Project: Z 2 co 00 s
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
%
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2n' 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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: `08=00000976
Property Address: `53075 -VIA CHIANTE
APN:' 772 -550 -010 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 22000
• I
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Owner:
BLAKE SCHWARTZMAN
53075 VIA CHIANTE
LA QUINTA, CA.92253
----------------------------
Contractor:
Applicant: Architect or Engineer: Owner
-------------------------------------------------
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.
License Class: License No.:
Date: Contractor:
- t
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Lia 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 plicant 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 toanowner 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
I - 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
---------------------
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 policyq umber are:
Carrier. Policy Number -
_ 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
rj4rA
of the Laboi Code I shall forthwit�i�6niply, with those visi
V pplicant:.''d`%�` /a✓ D''
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.
Date: 7/31/09
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
r ^ 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. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this
sccou y to ter upon the above-mentioned propeizct
o/iononn purpoi
Date: / 0 d (Signature (Applicant -or Agent
�l
e
LQPERDIIT
Application Number . . . . . 08-00000976
Permit . . . MECH POOL
l Additional desc .
Permit Fee . . . 26.00 Plan Check
Fee
6.50
Issue Date .. . . . 7/01/08 Valuation
0
Expiration Date 12/28/08
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 7/01/08 Valuation
. .
22000
Expiration Date 12/28/08
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 . . . 7/01/08 Valuation
0
Expiration Date 12/28/08. �.
Qty. Unit Charge 'Per
Extension
" BASE FEE
15.00
1.00 30.0000 EA EL'EC PRIVATE SWIMMING
------------------------------------------------------------------------------
POOL
30.00 .
Permit PLUMBING
Additional desc
Permit Fee 33.00 Plan Check
Fee
8.25 .
Issue Date . . . .. 7/01/08 Valuation
. . .
. 0
Expiration Date 12/28/08
Qty Unit Charge, Per
Extension
BASE FEE
15:00
2.00 6.0000 EA PLB FIXTURE
12.00
1.00 3.00.00 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
LQPERDIIT
Application Number
. . . . . 08-00000976
,.Special Notes and Comments
-----------------
PLACE AT PRE -PLASTER
INSPECTION.
EQUIPMENT ENCLOSURE
NOT INCLUDED.
Other Fees . . .
. . . . . REPLACEMENT
-- ----------------
INSP CARD
15.00
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
--
329.00
--------
329.00
---------- ----------
.00
.00.
Plan Check Total
172.25
172.25
.00
.00
Other Fee Total
15.00
.00
.00
15.00
Grand Total
516.25
501.25
00
15.00
LQPERMIT
0212.7/2009 10:45 FAX Cool -Air 2002/003
INSTAUATION CERTIFICATE' (Page 3 of ii) CF -6R
Site Address Permit Number
,5 3 0?, 5 V j 4 4W I A j t -t LaQ. a. �ur� 4.,a ,
An installation cottificate is required to be posted at the building site or made available for all appropriate inspections. (The
information provided on this form is required) After completion of final inspection, a copy must be provided to the building
depart neat (upon request) and the building owner at occupancy, per Section 10-103(a).
HVAC SYSTEMS:
Heating Equipment ��y t ���•
Equip Type
CEC Certified M$.
Nemo and Model
# of
Identleal
Efficiency o
(AME, 01e.)
'
Duct
Locasion
butt or
Piping
Heating
Loud
Hating
Copacity
heat
Number -
S
2CF-1R value
attic, Cie.)
R -value
wft
(Btuthr
�4rJ �ttv
V",Vw,,,,,L.000a
L
�►r�
4 . `
Q,- "$
18,000
Goya � kll • ��
� � Z N33te 4tCti'
Z
14 Apr"
T
!� —�i
18,000 .
A`
Cooling Equlpment
.. -J�& Y I j t [aNY"
Epp Type
(Pkg. heat
CEC Cornified Mfr,
Ngme and Model
Number
0 or
Identical
S temsLICF-IR
Eff`eieney I
(SEER or EER)
valae
Duct
Location
anti etc.
Duct
R -value .
Cooling
Load
M41r(B=/hr)
Cooling
Capacity ..
l
13 , y
Ar <.&
X -S
Cd.�D..la .'�w.w'
Y�lz�i3 �S �►ICa
Z
t3 . 9
A'r�r-,t.
Q,- "$
18,000
Goya � kll • ��
� � Z N33te 4tCti'
1
� 3 . ci
/err. c_
R. -� '
3fo,�o
1. > symbol reads greater than or equal to what is indicated on the CF -1R value.
Include both SEER and EER if compliance credit for higb EER air conditioner is claimed.
✓ k1, the uudersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or
more efficient than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the
Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable.
Installing Subcontractor (Co. Name) OR General
Contractor (Co. Name) OR Owner
rZ W eAr in,V cv )r A i a� 4e o u v, n o 4 a) (w
Signature;
Date:
Coptea to; BUILDING DEPARTMENT, HERS RATER'(IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005