07-3112 (RPL)we
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
• ,r
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant:
Architect or Engineer:
qlk.
~ Owner:
MITCHELL RESIDENCE
52-958 VIA DONA
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
OF
�.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - L - - - - - - - --- - - - — — I
` LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSAT 'I,'
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following d9' a ns:
Section 7000) of Division 3 of .the usine nd Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent elf sure for v
License Class: C53 License No.: 802919 for by Section 3700 of the Labor Code, for he pe ormance of
issued.
j� /�j �I�
DatC ! Cdntractor:`-X ` _'I have and will maintain workers' compens ion in nce,L
t I �_ •r V Code, for the performance of the work r which t ermit rs
OWNER -BUILDER DECLARATION - insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier SIRIUS/DELOS Policy Numbe
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for whic
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the w
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State ' and agree that, if I should beco a subject to the workers' c
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 37661 of the Labor Code, I sh I hw't omp with those pi
that he or she is exempt therefrom and the basis for the alleged exemption. 'Any violation of Section 7031.5 by I I
- , • ��
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: DatelApplicant:
( 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and �rJr
Date: 12/10/07
1
---------------
no _
f '.comp anon, as provided
hea, for vyiliL is permit is -
eq by Sectio 700.of thPan
bor ,
e y worke ' co on
OO��QD
s ued, I s all no y .
tion law f a,-
isi s ction
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
T f
07-0000311 j
Application Number:
Property Address:
5295`8 VIA DONA
APN:
772-410-999-11 -298944- -'
Application description:
POOL -.RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
28900 .
Applicant:
Architect or Engineer:
qlk.
~ Owner:
MITCHELL RESIDENCE
52-958 VIA DONA
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
OF
�.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - L - - - - - - - --- - - - — — I
` LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSAT 'I,'
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following d9' a ns:
Section 7000) of Division 3 of .the usine nd Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent elf sure for v
License Class: C53 License No.: 802919 for by Section 3700 of the Labor Code, for he pe ormance of
issued.
j� /�j �I�
DatC ! Cdntractor:`-X ` _'I have and will maintain workers' compens ion in nce,L
t I �_ •r V Code, for the performance of the work r which t ermit rs
OWNER -BUILDER DECLARATION - insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier SIRIUS/DELOS Policy Numbe
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for whic
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the w
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State ' and agree that, if I should beco a subject to the workers' c
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 37661 of the Labor Code, I sh I hw't omp with those pi
that he or she is exempt therefrom and the basis for the alleged exemption. 'Any violation of Section 7031.5 by I I
- , • ��
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: DatelApplicant:
( 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and �rJr
Date: 12/10/07
1
---------------
no _
f '.comp anon, as provided
hea, for vyiliL is permit is -
eq by Sectio 700.of thPan
bor ,
e y worke ' co on
OO��QD
s ued, I s all no y .
tion law f a,-
isi s ction
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). -
APPLICANT ACKNOWLEDGEMENT '
. (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
' 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
-
conditions and restrictions set forth on this application.
pioperty who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed.
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). -
whose benefit work is performed under or pursuant to any permit issued as a result'of this application,
_
(_) I am exempt under Sec. , B.&P.C. for this reason - -
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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:
LQPERDIIT - -
• . 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, of 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
itcity ani cou ordi an es and state laws relati ing �truction, and hereby authorize representatives
t f slcol�r>!y f rr uu on the above-mentio d pPo erty fo ns ection purposes.
naro- a 1 Ic;nna., ro rnnnr an. , c7§.�'
Application Number 07-00003112
Permit BLDG POOL PERMIT,.:
Additional desc .
Permit Fee 278'..00 Plan Check Fee
.180.70
Issue -Date Valuation.
28900
Expiration Date 6/07/08
Qty Unit Charge Per.
Extension'.
BASE 'FEE..
252.00
•4..00 6..5000 THOU BLDG 25,001-510,000
26.00
. Permit . . MECH POOL
Additional desc ..
Permit Fee . . . 26.00 Plan Check Fee
6.50
Issue Date- Valuation
0
Expiration Date 6/07/08
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 6/07/08
Qty. Unit.Charge Per
Extension
BASE FEE
15.00
1.00 30.0000 EA, ELEC PRIVATE SWIMMING POOL
30:00
PermitPLUMBING
Additional desc .
Permit Fee 45.00 Plan Check Fee
11'.25
Issue Date Valuation . . . .
0
Expiration Date 6/07/08
Qty Unit -Charge Per
Extension
BASE FEE
15-.00
4.00 6.0000 EA PLB FIXTURE
24.00
1.0.0 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
r
i'.
Bin #
*
,- =City of La Quinta
Building U Safety Division
P.O. Box 1504, 78=495 Calle Tampico
* •'La Quints, CA' 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit.#
1
F, v
Project Address: Z-q;Y V 1 OL
Ownei's Name:
A.P. Number:
Addressx�,z ' Q v , Lj -
t
Legal Description:.
`City, ST, Zip: v
Telephone: _ t.
Contractor:
,Address: , . O' �( %
ProjectDescr n:
City, -ST, Zip: 'Pa/At .e,�e
Telephone: � •;
• , - -
State Lic. # : gQ
City Lic. #:
_ . i- 464 r,
A�cch. Engr., Lles�er:
�
'Address: '
,
,City; ST; Zip: y � � � — ! 2, Q�%
•
Telephone.'1
s
x •
Construction Type: Occupancy: t
State Lic. #: �j�'i('1
Project type (circle one): ew Add'n Alter . Repair Demo ,
Name of Contact Person:
e ��
Sq. Ft.:, _
# Stories:
# Units:
Telephone # of Contact Person: , -2-77— b0lrj
Estimated Value of Project:_ Q
71 APPLICANT:,DO NOT WRITEBELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING . _
PERMIT FEES
-
Plan Sets - -
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections 4
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance .
Energy Cates-.
Plans picked up
Construction
'
Flood plain plan
Plans resubmitted
Mechanical.'
'Grading plan'
1 .
2" Review, ready for corrections/issue
Electrical
t
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 i
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
w
Total Permit Fees
n
-
1
-
= ■
LIC# C-53, 802919
POOL SPECS
POOL SIZE: 19'X31'6"
POOL AREA: 621 SF.
POOL PER: 195 FT.
POOL DEPTH:
SPA SPECS
SPA SIZE: 6'
SPA AREA: 46 SF.
SPA PER: 27 FT.
EQUIPMENT
PUMP:
FILTER:
HEATER:
POOL LIGHT:
SPA LIGHT:
FINISHES
DECK AREA:
PLASTER:
TILE:
1 "=8' SCALE
MITCHELL
RESIDENCE
A imumrtchell(ResidenceMrA
,Lot, l l- D —The Hideaway t ''
x .
1'
52-958 Via'�Dona�- ' _
LQuinta, CA- 92253. , , a4,`t
- R - Azure Pools & Spas, Inc
PO "Box 10641
T.
' Pgb0,Desert ,-CA 922"55
• ' �: s License # 802919
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V4. Mitchell Residence' `
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•�`52 958 Via Dona-
. - La Quinta, CA 92253;
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