04-3893 (RPL)BUILDING & SAFETY DEPARTMENT
1504 (760),777-7012
c�AtOP��� 78°49 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number .
. . . .. 04-00003893 Date
5/07/04
Property Address . .
. . . . 57530 BLACK DIAMOND
APN:
762-350-033-88 -29147 -
Application description
. . . POOL - RESIDENTIAL
Property Zoning . . .
. . . . LOW DENSITY RESIDENTIAL
Application valuation
. . . . 15000
Owner
Contractor
------------------------
EIDE GREG/DEBBIE
------------------------
MCINTYRE POOLS.& SPAS,
INC.
57530 BLACK DIAMOND
P.O. BOX 1791
LA QUINTA
CA 92253 LA QUINTA CA
92253
(760) 342-3612
WCC: HRH INS
WC: 176911104
01/01/05
CSLB: 614611
09/30/05
CCC: C53
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Permit
MECH POOL
Additional desc
Permit Fee
24.00 Plan Check Fee
6.00
Issue Date . . .
Valuation . . . .
0
Expiration Date
5/07/05
Qty Unit Charge
Per
Extension
BASE FEE
. 15.00
1.00 9.0000
EA MECH FURNACE <=100K
9.00
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Permit . . . .
BLDG POOL PERMIT
Additional desc
Permit Fee . . . .
162.00 Plan Check Fee
105.30
Issue Date . . . .
Valuation . . . .
15000
Expiration Date
5/07/05
Qty Unit Charge
Per
Extension
BASE FEE
45.00
13.00 9.0000
THOU BLDG 2,001-25,000
117.00.
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Permit . . . . . .
ELEC POOL PERMIT -RES
Additional desc . .
Permit Fee . . . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation
0
Expiration Date
5/07/05
Qty Unit Charge
Per
Extension
P.O. BOx 1504�� VOICE (760) 777-7012
78-495 CALLE TAMPICO T-Vf 4 FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Date:
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
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 Class Liceennsse, No.
Date . rb Ln qcontractorm'--�:1 �I ( 4 Pun
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' 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.
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
is d. Myrorkers' compe tion insurance carrier olic ny�lbar r :
Cartier (� i�l _ ) Policy Number Zo j �
_ I certify that, in the perfdtTnance of the work for which this p rm tssu6d, l 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
forthwith comply with those provisions.
Date /Q� Applicant
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.
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
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 hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
Date Zi Signature (Applicant or Agent): Y
a
CI
Page 2
Application Number .
. . . . 04-00003893
Date 5/07/04
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
.1.00 30.0000
EA ELEC
PRIVATE SWIMMING POOL
30.00
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Permit . . . . . .
PLUMBING
Additional desc
Permit Fee . . . .
33.00
Plan Check Fee
8.25
Issue Date . . . .
Valuation . .
. . 0
Expiration Date
5/07/05
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 ONLY. ALARMS
BARRIERS
SHALL
BE IN PLACE PRIOR TO
PREPLASTER
INSPECTION.
Fee summary Charged
---------------------------
----------
Paid Credited
----------
Due
----------
Permit Fee Total
264.00
.00 .00
264.00
Plan Check Total.
130.80
.00 .00
130.80
Grand Total
394.80
.00 .00
394.80
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April 29, 2004
Mr. & Mrs, vreg Eide
FAIRWAYS ASSOCIATION
RE: 57-530 Black Diamond
Pool and Spa
Dear Mr. & Mrs. Eide:
On April 19"', 2004, the Architectural/Landscape Committee reviewed your
submitted plans and has given their approval for installation as all of the fol{owin
conditions have been met:
• Adjacent neighbor comment forms - submitted
• Before photos required — submitted
• Property line not indicated on plans — done
• Boulder specifications • done
Thank you for your cooperation in this matter. If you have any questions, please
do not hesitate to contact this office.
Sincerely,
Nan e, CACM, CLAM
Association Manager
N D/i icp
CC: McIntyre Pools
Post Office Box 1658 • La Quinta, California 92253 • Phone (760) 776-5100 - Fax (760) 776-5111.