07-3198 (SOTB)P.O. BOX 15041,
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
,Property Zoninq:
Application valuation:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
X07^--`00003198 7
81928 RUSTIC CANYON DR.
764-280-999-69 30.0237 -
STRUCTURES OTHER THAN'BUILDINGS
.MEDIUM HIGH DENSITY RES
1000
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 Icommencing with
Section 7900) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License ass: ,C53 License No.: 614611
ate: tractor: � W
OWNER-BUI DER 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).:
(_ I 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 1, 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 _) 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:
LQPERAIIT
Owner:
NOLAN
81928 RUSTIC
LA QUINTA, CA
CANYON DRIVE
92253
Contractor:
MCINTYRE POOLS & SPAS, -
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: 12/21/07
WORKER'S COMPENSATION DECLARATION
1 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.
X 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 Labo Co I all forthwith comp) r ' it those provisions.
icant: N `
V1.
WARNI G: 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 aresult 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 J j
city and co n_ ty ordinances and a laws relating to buildin conffn
, and hereby authorize representatives
of this t o ter upon above-mentioned grope Mro
ate gnature (Applicant or Agent):
p
Application Number . . . 07-00003198
Permit . . . . BUILDING PERMIT
Additional desc -
Permit Fee 25.00.'
Plan Check
Fee ..
16.25
Issue Date
Valuation
. .
. 1000
Expiration Date 6/18/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
5.00 2 . 0000 TINT) RTd)A 501 -2,
nnn
10.00
---------==---------- ------------------------------------------------
Permit PLUMBING
Additional desc .
Permit Fee . . . 18.00,
Plan Check.Fee
4.50
Issue Date
Valuation
.0
Expiration Date'. 6/18/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS PIPE
1-4 OUTLETS
" 3.00
Special Notes and Comments
FIREPIT (496AGAL), 30000 BTU, 60.L.F.
OF 1 1/2" GAS LINE
-------------------------------------------------------------------
Other Fees . . . . . . . . . ENERGY
REVIEW FEE
----------
1.63
STRONG
MOTION (SMI)
- RES
.50
Fee summary Charged Paid
Credited
Due
Permit Fee Total. 43.00
.00
.00
43.00
Plan Check Total 2.0.75
.00
.00
.20.75 r
Other•Fee Total 2.13
.00
.00
2.13
Grand Total 65.88
.00
.00
65.88
i
r
Bin #
City of La Quinta
Building at Safety Division
X
X
%D
X
Permit #
may,`
J
Project Address:X -7- Z
A. P. Number:Address:
Legal Description:
Contractor: �ry
Address:
7 '
Cit}•. ST. Zip: L,
P.O. Box 1504, 78.495 Calle Tam rico
La Quinta, CA 92253 - (760) 777-7012 .
Building Permit Application and Tracking Sheet
SA t ( OHrer's Namc:
S.
_
SI
Cin. ST. Zi '
Telephone: E
Project Description:
22- S ��
X
Telephone: L
2 _
A
State Lic. # : �
Citv Lic. #:
Arch.. Engr., Designer:
Address:
City. ST. Zip:
Telephone:•
i
:_.. -.. Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
A
Name of Contact Pctson:
Sq. Ft.:" S #Stories: # Units:
X'
Telephone # of Contact Person:
stimated Value Proiect:
of l7, Q[,Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
p Submittal Req'd
Recd TRACKING
PERMIT FEES �
Plan Sets
Plan Check submitted j
Item
Structural Coles.
Amount
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
Mahanical
Grading plan
2" Review. ready for corrections/issue Eleerical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M..
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review. ready for corrcciionsrissue Deve'oper Impact Fee
Planning Approval
Called Contact Person
�i'ks A p p r
A.I.P_P.
HPub.
Date of permit issue
School Fees
I
Total Permit Fees