07-2473 (RPL)P.O. BOX 1504
7&'495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Applicant: Architect or Engi
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
SEP 1 o 2007
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 full force and effect.
License CI : C53 License No.: 614611
aLr—D-14� I ho Contrac�__tor: /)
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 _ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnot 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 ISec.
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 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:
LQPERMIT
Owner:
MEYER RESIDENCE
81-757 RUSTIC CANYON DR.
LA QUINTA, CA 92253
Contractor:
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: 9/05/07
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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:
Carrier MAJESTIC INS CO Policy Number C20060333602
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
C I shall forthwith c p with those provisions.
Date: Applicant: W-f;A
_.i,ce--- - -
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 1$100,0001. 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 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 b rildin construction, and hereby authorize representatives
of%ty to enter upon the above-mentioned pr ty or ins ection purposes.
Signature (Applicant or Agen
Application Number:__
_07_00002473____�7
Property Address:
81757 RUSTIC CANYON DR
APN:
764-280-999-41 -300237-
Application description:
POOL - RESIDENTIAL
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
20000
Applicant: Architect or Engi
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
SEP 1 o 2007
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 full force and effect.
License CI : C53 License No.: 614611
aLr—D-14� I ho Contrac�__tor: /)
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 _ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnot 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 ISec.
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 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:
LQPERMIT
Owner:
MEYER RESIDENCE
81-757 RUSTIC CANYON DR.
LA QUINTA, CA 92253
Contractor:
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: 9/05/07
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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:
Carrier MAJESTIC INS CO Policy Number C20060333602
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
C I shall forthwith c p with those provisions.
Date: Applicant: W-f;A
_.i,ce--- - -
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 1$100,0001. 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 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 b rildin construction, and hereby authorize representatives
of%ty to enter upon the above-mentioned pr ty or ins ection purposes.
Signature (Applicant or Agen
Application Number .
. . . . 07-00002473
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit.Fee.'.
207.00 Plan Check Fee..
134.55
Issue Date . . . .
Valuation
20000
Expiration Date..
3/03/08
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 ,9.0000
THOU BLDG 2,001-25,000
162.00
Permit
MECH POOL
' Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date.
3/03/08
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
3/03/08
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 Plan Check Fee
8.25
Issue Date
Valuation . . .
. 0
Expiration. Date
3/03/08
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 . . . . 07-00002473
---- ---------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
Fee summary Charged
Paid
Credited
Due .
----------
Permit Fee Total 311.00
.00
---------- ----------
.00
311.00
Plan Check Total 160.55
._00
.00
160.55
Grand Total 471.55
.00
on
471.55 _-
Bin #
ti
?elmit #
. 7-f
1� Project Addres '_
A. P. Number:
Legal Description:
X Contractor:
J� Address:
X Citi•, ST, Zip:
X Telephone:. 425k 1 Z
A State Lic. #
Arch., Engr., Designer:
Address:
City. ST. Zip:
Telephone.
State Lic. #:
A Name of Contact Person:
X Telephone # of Contact Person:
# Submittal' Re 'd
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Cales.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta
Building at Safery Division
P.O. Box 1504; 78.495 Calle Tampico
La Quinta, CA 92253 - (760) •777-.'012
Building Permit Application and Tracking Sheet
'L� 5� IC Grv�12. 0„rer•s Name: ,
Address:14,-TCi
// Cin. ST. Zip: �) �%� ' 12,
C..S-4,Usr C, FTelephone: :_�•::c�',ti
VeProject Desc iption:
City Lic. #:
Tota? Permit Fees
Construction. Type:
Occup ant] :
Project type (circle one):
New ” Add -n Alter Repair Demo
Sq. Ft.:.36 t✓t
#Stories:
# Units:
[AEstimatcd
Value of ProieCt' a
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd
TRACKING
PERMIT FEES
Plan Check submitted
9
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
h1lecianic21
2' Review, ready for corrections/issue
Electrical
Called Contact Person
Plutrbing
Plans picked up
SAI.1.
Plans resubmitted
Gracing
'"' Review, ready for corrections/issue
Developer Im.Pact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Tota? Permit Fees