12-0642 (RPL)P.O. BOX 1504
78-495 CALL TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:•
12,
:+ t. b4 2
Property Address:
81663 BAFFIN AVE
APN:
767-200-998-113 -330762-
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
75000
Titvl 4 etP Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/11/12
Contractor: L16
Applicant: Architect or Engineer: MCINTYRE POOLS & SPAS, IN
83695 AVENUE 45 INDIO, CA 92201 (760)342-3612
LiC. No.: 614611 pi
LICENSED CONTRACSO ECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisi ns of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, an my License is in full force and effect.
License C
lass: C'53 License No.: 614611
///–nate: ntractor:
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).:
(_) 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-builde( will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
1 _ I 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.
I—) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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
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
b(�y,/ issued.
l 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 COMMERCE WEST I Policy Number 00330843590
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
700 of he Labor Code, I shall forthwith comply with those provisions.
-
bate: T 7 Applicant: P ..wi
(
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 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 he by authorize representatives
of t coun y to enter upon the above-mentioned property f in 'on pur
ate: gnature (Applicant or Agent): i
Application Number . . . . . 12-00000642
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 527.00 Plan Check Fee 342.55
Issue Date . . . . Valuation 75000
Expiration Date 12/08/12
Qty Unit Charge Per Extension
BASE FEE 414.50
25.00 4.5000 THOU BLDG 50,001-100,000 112.50
----------------------------------------------------------------------------
Permit . . . MECH POOL
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee-. 6.50
Issue Date . . . . Valuation 0
Expiration Date . . 12/08/12
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 : 12/08/12
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 12/08/12
Qty Unit Charge Per Extension
BASE FEE 15.00
2.00 6.0000 EA PLB FIXTURE 12.00
1.00 310000 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, 4 WATER FEATURES (INCLUDES 5
LQPERMIT
Application Number . . . . . 12-00000642
----------------------------------------------------------------------------
Special Notes and
Comments
PUMPS) & FIREPIT.
ALARMS/BARRIERS SHALL
BE IN PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. 2010
CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
4.00
Fee summary
Charged Paid
Credited
Due
--- --------------
Permit Fee Total
--------------------
631.00 .00
--------------------
.00
631.00
Plan Check Total
368.55 .00
.00
368.55'
Other Fee Total
4.00 .00
.00
4.00
Grand Total
1003.55 .00
.00
1003:55
LQPERMIT
Bin #
City Of L Quinta /n
Building 8z Safety Division lL
P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1-"
Project Address: 3 yl a0P
Owner's Name:7,s
A. P. Number: MCtd, �N e(01) 11S6Address:
Legal Description:
City, ST, Zip:
Co
5
r.,�v..
Telephone:
Address: —tS S
Project Description: �1
City, ST, Zip: (^
Telephone:
State Lie. # : ('
City Lic. #, Z S
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone: Construction Type: Occupancy:
State Lic. Project type circle one New Add'n Alter Repair Demo
Name of Contact Person: Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: Estimated Value of Project: % S
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cates.
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Plan Check Balance •
Title 24 Cates.
Plans .picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
206 Review, ready for corrections/issue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A- Approval
Plans resubmitted Grading
IN HOUSE:-
"Reylew,.ready for correctionsflssue Developer Impact Fee
Planning Approval
Called Contact Person AJ.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees