09-1118 (RPL)IIIIIIIIIIIIIIIIIIII# 69
IE
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00001118
Property Address: 54195 AFFIRMED CT
APN: 767-320-999-299 -32879 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 21950
c&t!t 4 4v Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DUNN
54195 AFFIRMED COURT
LA QUINTA, CA 92253
Contractor:
Architect or Engineer: MCINTYRE POOLS & SPAS, INC.
83695 AVENUE 45
INDIO, CA 92201
(760) 342-3612
Lic. No.: 614611
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/22/09
tOt22
CITYOF G4 oulnii. i
-------------------------------------------------------------------------------------------------
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: C53 License No.: 614611 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
/ate: tractor: I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
t/ Code, for the performance of the work for which this permit is issued. My workers' compensation
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.).
(_ 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 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. , BAP.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
insurance carrier and policy number are:
Carrier DELOS INS CO Policy Number 02DKRM120001870
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
3�70_0� of the Labor Code, I shall fo fiwh ply with those provisions.
te: _�'/,)� scant•
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 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 1 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 county to enter upon the above-mentioned property for insp ionpurposes.
i
Date: 444 Qv nature (Applicant or Agent
Application Number . . . . . 09-00001118
Permit
BLDG POOL PERMIT
Additional
desc . .
BASE FEE
Permit Fee
225.00
Plan Check Fee
146.25
Issue Date
. . . .
Valuation . . .
. 21950
Expiration
Date 4/20/10
3.00
1.00
Qty
Unit Charge Per
GAS PIPE 1-4 OUTLETS
Extension
-------------------------------------------------------------------------.---
Special Notes and Comments
BASE FEE
45.00
20.00
----------------------------------------------------------------------------
9.0000 THOU BLDG 2,001-25,000
SHALL
180.00
Permit.
. . MECH POOL
Additional
desc . .
Permit Fee
. . 26.00
Plan Check Fee
6.50
Issue Date
. . . .
Valuation'
0
Expiration Date . . 4/20/10
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 4/20/10
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
Issue Date . . . .
Expiration Date . . 4/20/10
Plan Check Fee . . 8.25
Valuation . . . . 0
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 . . . . . 09-00001118
----------------------------------------------------------------------------
Special Notes and
Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
2007
CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged
---------- ----------
Paid
Credited
------ - --- ----------
Due
-----------------
Permit Fee Total
329.00
.00
.00
329.00
Plan Check Total
172.25
.00
.00
172.25
Other Fee Total
1.00
.00
.00
1.00
Grand Total
502.25
.00
.00
502.25
LQPERMIT
Bin #
City of LaQ uinta . .
Building a Safety-Division
Box 1504, 78-495 Calle Tampico
La Quirita, CA 92253-'(7¢0) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
X000
OR.
Project Address: _ S
5
'C m )
Owner's Name:
A. P. Number:
Address:. _ r
.vlt�ped OV,
al Description:
tractor: i. �o S
ress: 3, V ..
City, ST, Zip: Q
Telephone:
J
Project Description:.90
, ST, Zip:2Z0phone:
[Ad
Lic. # : – �j .
City Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lit. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n 'Alter Repair Demo
m
Nae of Contact Person: �e Y
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact-Person:' S-0. - !876 Z
Estimated Value -of Project:
APPLICANT:
DO NOT WRITE BELOW THIS LINE .
#
Submittal
Req'd -
Rec'd
TRACKING
PERM .r 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' .
21" Review, ready for corrections�ssue
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 correctionglissue
Developer Impact Fee
Planning Approval '
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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