BPOL2018-000778-495 CALLE TAMPICO C D �NM1A�il/
LA QUINTA, CALIFORNIA 92253 DESIGN &•DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: POOL/PRIVATE
Application Number: BPOL2018-0007
Property Address: 53149 VIA DONA
APN: 777380016
Application Description: BOZICK / POOL / SPA/ 2 WATER FEATURES / FIRE PIT
Property Zoning:
Application Valuation: $25,000.00
Applicant:
REMBRANDT POOLS AND SPAS INC JAN 2 4. 2018
P0BOX 6411 . D
LA QUINTA, CA 92248 CITY QF LA QUINTA
DESIGN AND DEVELOPMENT DEPARTMENT
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 Divisiori 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class: C53, C27 G License No.: 800680
Date: �r Q Its / 0 Contractor+_
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'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.).
(� 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 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 Na
Lender's Address:
VOICE (760) 777-7125
FAX (760) 7.77-7011
INSPECTIONS (760) 777-7153
Date: 1/24/2018
Owner:
48D VIA DONA, LLC
LA QU I NTA, CA 0
Contractor:
REMBRANDT POOLS AND SPAS INC
P0BOX 6411 '
LA QUINTA, CA 92248
(760)771-2121
Llc. No.: 800680
WORKER'S COMPENSATION DECLARATION .
I hereby affirm 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 vork 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: EXEMPT 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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date:. 4C/e- t v Applicant:
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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official 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.
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 this city to enter upon the above-
mentioned property for inspection purposes.
Date:Signature (Applicant or Agent):
a
Date: 1/24/2018
S -
Application Number: BPOL2018-0007
Owner-
wner:
Proper
Property Address: 53149 VIA DONA.
48D VIA DONA, LLC
APN: 777380016
Application Description: BOZICK / POOL / SPA/ 2 WATER FEATURES / FIRE PIT
LA QUINTA, CA 0
Property Zoning:
Application Valuation: $25,000:00
Applicant:
Contractor:
REMBRANDT POOLS AND SPAS INC
REMBRANDT POOLS AND SPAS INC
P0BOX 641'1
P0BOX 6411
LA QUINTA, CA 92248
LA QUINTA, CA 92248
(760)771-2121
Llc. No.: 800680
Detail: POOL, SPA, FIRE PIT IN SIDE YARD [DENISE POELTLER ENGINEERING] [2) WATER FEATURES
AT FRONT ENTRY.POOL EQUIPMENT AT SOUTHEAST
CORNER OF YARD. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2016 CALIFORNIA BUILDING CODE.
a
FINANCIAL ,• {.
DESCRIPTION ' ACCOUNT QTY AMOUNT
BSAS SB1473. FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS.
101-0000-42401
0
$13.00'
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$26.01
Total Paid for PLUMBING FEES: $39.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DETACHED SPA/WATER FEATURE/OTHER
101-0000=42404
0
$390.10
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SWIMMING POOL/SPA
101-0000-42404
0
$195.05
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SWIMMING POOL/SPA PC
101-0000-42600
0
$106.11
Total Paid for POOL / SPA: $691.26
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE! $10.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
W W .
- OOPERMIT # aid.
PLAN LOCATION:
Project Address: �`' — �� V !� bvj o,
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
N •t PV ii ( 4 S h CU
C& It 4. 7G o 577
Applicant Name:
State Lic: City Bus Lic:
Address:.
State Lic: City Bus Lic:
City, ST, Zip:
Telephone: (J
Email: 3G( `e^ 5st �� ^ K , L ��
Valuation of Projects �, 61610
Contractor Name: y( �T— Uas 4 �J
New SFD Construction:
Address: `� /
Conditioned Space SF
City, St, Zip
Garage SF
Telephone:
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lic: City Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Construction Type: Occupancy:
Telephone:
Bedrooms:
Stories:
# Units.
Email:
State Lic: City Bus Lic:
Property Owner's Name: IgZ V IQS ,.�,V,
New Commercial /Tenant Improvements:
Address: 3 _ ILI
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone:.
Email:
78495 CALLE TAMPICO
LA QUI NTA, CA 92253
760-777-7000
OFFICE USE ONLY
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S"Mi ' a ' v t,'
Req'd
•.Rec'd
`
Plan Sets
t
Structural Calcs
,
Truss Calcs
Title 24 Calcs
Soils Report
Grading Plan (PM 10)
-mss •1 •.,� �.
L e.t 1� i � •..ry .` .
Landscape Plan
r
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
'
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yr
CITY
OF LA GUINTASUB-CONTRACTOR LIST 7
JOB ADDRESS—T., - PERMIT, NUMBER OWNER q, BUILDER
This form shall be posted on the job with the Buildiiiq Inspection Card at all times in a conspicuous place. Only persons",a'ppearing on this list or their employees are authorized to work
on this job. 'Any changes to this list must be approv'ed by the Building Division prior to commencement of work. Failure to comply will result in 'a stoppage of work ana/or.,the voidance
of. building permit. For each applicable trade, all information requested below must be completed by applicant. "On Filej,is not an acceptable response.
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