10-0715 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000715
Property Address: 78885 VIA FLORENCE
APN: 643-130-062-103 -26152 -
Applicatiori description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 13500
(F-4'�v 4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
RIEBOLDT THOMAS J
78-885 VIA FLORENCE.
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer: CLASSIC POOLS & SPAS
79461 AVENUE 40TH
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/03/101
etU S 0 t 2010
I 1
k BERMUDA DUNES, CA 922 3 C4TV aF LA c1u1wT4
(760)413-4867 Fi'lAN! ,'E.0Ell2T
_\ Lic. No.: 935936
---------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
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 declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C13-053 License N .: 935936 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. -
ate:_ 7 d ontractor: 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
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 NATIONAL INS Policy Number 200090117388
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 which this permit is issued, I shall not employ any
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 workers' compensation laws of California,
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 become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or _ 3700 of the Labor Code, I shall forthwith comply with those provisions.
thathe or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by [/
any applicant forpermit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: e: T l icant: Gam.✓ �C�. -
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 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
(_ 1 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.
property 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
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
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 th' county to enter upon th ove-mentioned property pectio uryp rposes.
ate: SWdaturelApplicant or Agent): -
Application Number 10-00000715
Permit . . MECH •POOL
Additional desc .
Permit Fee . . . 26.00 Plan Check Fee
6.50•
Issue Date . . . . Valuation
0.
Expiration Date 1/30/1.1
Qty Unit Charge Per
Extension
BASE FEE
15.00 -
1.00 11.0000 EA MECH FURNACE >100K
11.00
Petw_L . . . PLUMBING
Additional desc .
Permit Fee . . . 33.00 Plan Check Fee
7.50 _
Issue Date . . . Valuation. . . .
0
Expiration Date,. 1/30/11
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
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 15.00 P1an..Check Fee
.00
Issue Date . . . . Valuation
208
Expiration Date 1/30/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes and Comments
REMODEL POOL: ADD 13 L.F. 4' BLOCK WALL,
CITY STANDARD, INSTALL NEW EQUIPMENT IN
SAME LOCATION AND RE -PLASTER. 2007
CODES.
------------------------- --------------------- --------
Other Fees . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 74:00 .00 .00
74.00
Plan Check Total 14:00 .00-- - .-00
14.00
Other Fee Total 1.00 .00 :00
1.00
Grand Total 89.00_ .,00 .00
89.00
LQPERMIT
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Bin #
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ty Quinta
Budding 8t Safety Duron
P.O. Box 1504, 78-495 Calle Tampko
La Qufita, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permlt #
O , /\0
Project Address: 7R—
Owner's Name:
A. P. Number.
Address:' S- (! _ to �_ely C42
Legal Description:
Contractor: ' , .
Cite, ST, Zip: o�
Telephone:--�----.
Project Description:
Address: Q (ev•`- V
City, ST, Zip: /?
m
Telephone: -24(,
State Lie. # : C-612 - ?2 City Lie. #:
Arch., Engr.; Designer
bl. Lk LAI
Address:
v
City., ST, tip:
Telephone:: , 36
State Lie. #:
l
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n . Alta Repair _ Demo
Sq. Ft : u
#Stories:
# Units:.
Telephone # of Contact Person:-% p
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS .UNE
#
Submittal
Req'd
Reed
TRACKMG
PERMIT FEES
Plan Sets
Plan Check submitted
�(j %
Item . Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Cheek Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction .
Flood plain plan
Plans resubmitted•Mechankal
2
Grading plan
2" Review, ready for correctionstissue
Electrical!
Subcoutaetor List
Called Contact Person
Piumbin, ";j -f
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading: .
IN HOUSE:
Review, ready for correctlonsassue
Developar Impact Fee
Planning Approval
-
Called Contact PersonA.LP.P.
Pub. Wks. Appr
Date of permit issue
JVA4 L
School Fees
Total Permit Fees
P `�Sstm�. Loco4T�a
/oGK IVA Ot. Ot.�itT /3 1,.F 4
AREA SCHEDULE
POOL
260 5q. Ft.
POOL PERIMETER
61 Ln. Ft.
POOL COPING
61 5q. Ft.
5PA
3q 5q. Ft.
5PA PERIMETER
22 Ln. Ft.
5PA 5PILLWAY
5 Ln. Ft.'
5PA GOPINC,
33 5q. Ft.
POOL DECK
600 5q. Ft
C7A5 LINE ;
100 Ln. Ft
4'. HIGH BLOGK WALL
135 Ln. Ft
18" RA15M BOND BEAM
35 5q. Ft