RPL (10-0801)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO AX 760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT D INSP TION (76 0) 7 153
BUILDING PERMIT
D /10
Application Number: 10-00000801 Owner: AUG 2 62010
Property Address: 57013 MERION MEREDITH
APN: 762-031-006- - - 57-013 MERION C�IYOFI.AQUINTA
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253 Pf.
Property Zoning: ' LOW DENSITY RESIDENTIAL
Application valuation: 26890
Contractor:
Applicant: Architect or Engineer: MCINTYRE POOLS & SPAS, INC.
83695 AVENUE 45
INDIO, CA 92201
(760)342-3612
Lic. No.: 614611
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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 Division 3 of the Business and Professionals Code, and my License is in fu`II force and effect.
License s: 53 �cens 10.: 614611
Dater ontractor:
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
anj pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ 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.).
(_ 1 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 Name:
Lender's Address:
LQPER1111T
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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 work for which this permit is
issued.
V__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 GOLDEN INS Policy Number 2010010139097Z
_ 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 forthytrithfomply with those provisions.
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 PROVIDEDTOR 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 Quinta, its officers, agents and employees for any act or omission related to the work being ;•
performed under or following issuance of this permit. i
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 cons uction, and hereby authorize representatives
of th' cou ty to enter upon a above-mentioned propert for in c 'on diposes.
ignature (Applicant or Agery�
Application Number . . . . . 10-00000801
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee
265.00 Plan Check Fee
172.25
Issue Date . . . .
Valuation . . .
. 26890
Expiration Date . .
2/21/11
Qty Unit Charge
Per
Extension
BASE FEE
252.00
2.00 6.5000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
13.00
Permit . . . MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
2/21/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
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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 . .
2/21/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
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EA ELEC PRIVATE SWIMMING POOL
30.00
Permit PLUMBING
Additional desc .
Permit Fee . . . .
33.00 Plan Check Fee
8.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
2/21/11
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'
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Special Notes and Comments
POOL/SPA, FIREPIT. ALARMS/BARRIERS SHALL
LQPERMIT
Application Number . . . . . 10-00000801
--------------------------7-------------------------------------------------
Special Notes and Comments
BE IN PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. 2007
CODES.
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Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 369.00 .00 .00 369.00
Plan Check Total 198.25 .00 .00 198.25
Other Fee Total 2.00 .00 .00 2.00
Grand Total 569.25 .00 .00 569.25
LQPERMIT
Bin #
Cit/ of La Quinta .
Building U SafetyDivision '
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (740) 777-7012
Build ing Permit Application and Tracking Sheet
Permit #
1 ,
Project Address;'
Owner's Name:
er g p
A. P. Number:
Address: Afe�0
Legal Description:
City, ST, Zip:
(�
Contractor:' %0.S
_
Address: j
C' r r ..
Telephone:
.
Project Description:. ,
City, ST, Zip:.
Telephone: Z _3 6.Z
State Lio. # : t l .3 - G 4G City Lic. #:.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lit. #:
JMName
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
of Contact Pelson: �n
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person: gC�
n,
Estimated Value.o�Proje�t: v
APPLICANT:
DO NOT WRITE BELOW THIS LINE .
#
Submittal
Req'd ,
RWd
TRACKING
PEVMTT FEES '
Plan. Sets
Plan Checksubmitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calls.
Plans picked up
Construction
Flood plain plan,
Plans resubmitted
Mechanical
Grading. plan'
2ed Review, ready for correctionslissue
Electrical -
Subcontactor-List
Called Contact Person
Plumbing
Grant'Deed
Plans. picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading -
IN ROUSE:-
''d Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees