04-3410 (RPL)1
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BUILDING & SAFETY DEPARTMENT
� CITY OF Lk� �v9E;`r�n
c m� FIfPO:�B°ox�l"504 (760) 777-7012
OFTt�'9 78-495 CALLE TAMPICO FAX (760).777-7011
LA QUINTA, CALIFORNIA.92253 INSPECTION REQUESTS.(760)'777-7153
BUILDING PERMIT
Application Number04-000034. 0 'Date 4/12/04
Property Address 6V 3 25 . .86.255 VIA VALEROSA
APN: 772-250-999--A7.-30357 -
Application descriptionPOOL - RESIDENTIAL
Property Zoning LOW.DENS.ITY RESIDENTIAL
Application valuation 26000
Owner Contractor
BERT"MCCHESNEY TOPMAN BUILDERS
80325 VIA VALEROSA P.O. BOX -10202
LA.QUINTA PALM DESERT CA192255
LA QUINTA CA 92253 (760)772-7296.
(T6b) ..27:51=-7359
WCC: AU INS'.SRVC:
WC: 0050.0019402. OT/01/05
CSLB:- :45512.1 11/30/05
CCC:.. B7C29._.
------------------ ---------- --------------=-- -
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.FURNANCE <=1OOK 9.00
'iermit : BLDG POOL PERMIT
Additional desc
Permit Fee 258.50 Plan Check Fee 168.03
Issue'Date . . . . Valuation' 26000-
Qty.
6000Qty Unit .Charge Per Extension
BASE FEE 252'.00
1.00 6.5000 THOU .BLDG 25,..001-50,000 6'.50
Permit . . . . . ELEC POOL PERMIT -RES
Additional desc
Permit Fee 45.00 Plan Check Fee 11.25
Issue Date Valuation.' 0
Qty ..Unit Charge Per. Extension
BASE FEE 15.00
1.00. 30.0000 EA _ELEC PRIVATE.SWIMMING POOL" .30.00
P.O. BOX 1504
VOICE (760) 777=7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS -(760) 7.77-7153
BUILDING & SAFETY DEPARTMENT
Application Number: O �/ — 3.�/ Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, andmy License is '�.�+ti force and effect.
License Class) _ "7� _ Licen No. — l `SSI
is � -
Date Contractor f
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury tha�Irn exe t from the Contractors' State License Law for the following reason. (Sec. 7031.5. Business and Professions Code: Any
city or county ttiat requires a permit to const 1 ,improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law Cha Pon 3 to file a signed
(Chapter 9 (commencing with Section 7000) of Division 3 of time 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 rive. hundred dollars ($500).):
U 1, 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 appy 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, haweyer, 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
WORKERS' 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:
Cartier Policy Number
I certify that, in fhe 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. an fkagree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, l shall
forthwith comply with those PMvW0K A
WARNING: FAILURE TO SECURE W RKER�SOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED OUDOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODET, AND ATTORNEY'S FEES.
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
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 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 Infomma n is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter the ove- mentioned property for inspection purposes.
Date �' ( ` - - —Signature (Applicant or Agent):
n
Page 2
.Application Number 04-00003410
Date 4/12/04
Permit PLUMBING
--------------
Additional desc .
Permit Fee... 33:00 Plan Check Fee
8.25
Issue Date . . . . Valuation
0
Qty. Unit Charge Per
Extension
BASE FEE
.00
2.00 6.0000 EA PUB FIXTURE
.15
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 AND SPA ONLY. ALARMS/BARRIERS SHALL
BE IN PLACE PRIOR TO PREPLASTER
INSPECTION.
Fee'summary Charged Paid Credited
Due
Permit Fee Total 360.50 .00 .00
360.50
Plan Check Total 193.53 .00 .00
193.53
Grand Total 554.03 .00 .00
554.03
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TIME, CLOCK UB PANEL
OF Po
.II"T5 OF LIGHT._ IN POOL II
9 T + ONC; Cel AND °,: �
.. � e�JT511 G.F.L. ,LIGHTS ,(".L. C.7U"f L.LT�.
STONE FACS LJCaHTaOSTR PUMA
GA. AQUA AIR -BAR 4 B,.OWER EXTRA SAITCH'f OR SPA LIGHT
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BLOWER ONLY
BLANK, PI_UGSS
TACT COLUMNST�° I'"+� RAKED SPA SPu,.Is�lAr=> 'MOTOR. Is3Gsc>5°r1�P,
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— _ CAPS,CONCRETE 57014E VENEER, SPECIAL NOrf5 51-op"IER OLEANER
FACE ANO YqATER SPILL TO BE
RMI
E C.AVA1TIO DETEMISC.
NED
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AGCE55FROM I IIA TILE
F_I_EVATION WIPING AHITE l
:: COPING SPECIAL
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F* END RAMP
RAISED. p °&' B P BMs^ INCE REMC�V#�i t TILE TYPE
CAP, STONE VENEER FACE AND FENCE TYPE MA5.I,IC R,+
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STONE h 9LL 1' TRASH RPMOVAL LADS L.B.B. I? �..�.. I5R.B.L.
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BROOM FINISH COLO CO _
CONCRETEREMOVALMISE.
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EXISTINTS 70 PZMAIN 11
' � °FI: SUICHAC,E D[..L:T' ENT? ” PLiLCCO DRAIN DIVIN' BOARD JIG
1.,OV>r SEATINSIDE Ft. OUTSIDE _ 1- w
-- — — SLIDE INSTAI_l_TION
ANLL � I 1.
:SPA NL I. A.. {Nlt T1� OTHER
MA50NRY-
- WALL DOAEL/MISG.
COPING 'I YPE
FLUMONC7 PLAN a
t L..R WALL
M I
(_
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FOR HIGH
SIT II� ..
FILTERSI.CL
5
_ ,.,.. POOL PUMP CAP a1_ I
(YI,HT IRON 5Y' �? nm.,. SIZE �,��.� UP wAu.. I �.
HEATER SIZE FOOTINGS R13:15. FACING
ly
BOOSTER: PUMP"' SIZE
t`IE';SPIi TYM,_ SIZE
,: � SKIMMER, 7Y'1yE
s EQUIP. WALL TYPE Ft. X
z
CARE � OF Hr AM�a
,, f°iNCINE E
0 T"4"I1.:R CI.:L:ANER, 5110 CYNLY
MISS.
FILL LINT.": SLIDE LINE
~v,
P -TRAP BACK NLASH TO PEBBLE
w�.
LGHTS'POO - �.
CAS LI M' 5,105
Lm SPA
F
#'OUNTAIN5l5PRA"Y'HEADS ROPE PINGS 1'EBALLS REQUIRED
1_IGHT5 IN POOL IN SPA
COI:..OR NAML: TLE
NEN
I STUB SET EQUIPMENT
POO
L I LL SPECIAL EWPMENT
T3 MATCH )CI
:p SAWCUT DIVING WARD SIZE
FR MISC.. MODEL COLOR.
C.�UN TE I
51..IDI.. SITE
q FI
YOPCL COLOR
E "KITE IN5PSSiCTION L iQUIRED' YES NO
POOL COVER SOL�CtiP^'. L-EA'."�,A I INC YLiS _ NO III III
ROPE RINGS GRAB RAILS
_ ,,��°° yy
r?F_fP END RAMP
TO MEET ALL LOCAL CODE R£_0UItC!:mENT5 BY tTUY1:".R PRIOR TO
6" RB.B.—I't. 1.2" F.D.O. ft. 15" RPB, PRE -PI -ASTER INSPECTION
LOVE. k1~AT ENTENDI�V 2nd 5111
TIS ....... ..._ _. _ :""__. " ",.. ryllll
NOTCHED BOND BEAM
11 IViul"
COPING CANTILEVER Ft.
SAP DAM WALL WIDTH
i
OI NEE. E5PtlONSI ILITIEE El
CJWN1;mR T"U:
(1) "p"'AKX htmorz THAT POOL AND IFOUIf'MFN'T (.LOCATION 15 SUBJECT TO ACCEPTANCE OF LOCAL BUILDING DEPARTMENT Al TIME
OF ISSUANCE( OF PERMIT
(2) TAKE NOTICE THAT PLATINUM POOL5 15 NOT RmPONSIBLE: FOR: UNDE.5R.OUND CONDITIONS OR OBJECTS, AND ANY DAM,NGS","
TO CUR55, 51DEWAL-KS, DRIVEWAYS, L ANNS, OR 01'1°'IIS ITEMS IN THE ACCE55 AREA
f (5) SLI': awr ALL. FENCING+, GATM AID GARAGE DOORS MEET LOCAL COD75 FOR A POOL ENCLOSURE PRIOR TO, PRE'PLASTER INSPECTION
(4) FILL POOL_ IMMEDIATELY AFTER PLAS I R (I'OL LOW INSTRUCTIONS,DO NOT USERUBBER HOSF)
(5) TAKE NOTICE 714AT" THIS:DRAYIAN& IS THE SOLE PP h"'ERT' Or: PLATINUM POOLSv AND THAT" ANY Q -5E WI'THOU"f LNRITTEN PERMISSION N
. III
OF PLATINUM'POOL,5 IS PROHIBITED BY LAW. '
q
OIANER APPROVES PLAN, POOL, AND EQUIPMENT LOrATIONS AND HAS RUAD THE RESPONSIBILITIES AND NOTICES ABO', E. ul�
IIYI
SIGNATURE (5; VAFE