05-3152 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
� �Ll�✓tet!
05-00003152
81745 BROWN DEER PARK
767-540-011- -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000
Architect or
BUILDING & SAFETY DEPARTMENT
BUILDINGTERMIT
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: License No.:
/e:Az_-z Contractor: C P ffJP
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 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.).
(_ 1 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:
LQPERMIT
Owner:
SWC NORMAN 39
C/O DAVID PEERY
7161 INDIANA AVE
RIVERSIDE, CA 92504
Contractor:
MCINTYRE POOLS & SPAS,
WCC: STATE FUND
WC: 1769111
CSLB: 614611
VOICE (760) 777-7012-..I
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
INC.
01/01/06
09/30/05
Date: 7/22/05
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.
/\ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
7� Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier C53 Policy Number - - - - - ---- -- - - - -
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 ubject to a work s' compensation laws of California,
and agree that, if I should becomes ject to th orker compensation provisions of Section
3700 of the Labor Code, I f hwith cc ly wit those provisions.
Applicant:/
WARNFAILURE TO SECURE �/0ERS"C0?h4 ENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMW S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). IN ADDITIN TO THE CT 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.
certify that I have read this application and state �thatth 'above informatio 's correct. I greet comply with all
city an county ordinances and state laws relatingildingcontio ;and hereby thori representatives
of thi count o enter upon the above-mentioned ertXo' ecY purposes.
Date: Signature (Applicant or Agentl:
Application Number . . . . . 05-00003152
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
207.00
Plan Check
Fee
134.55
Issue Date . . . .
Valuation
. . .
. 20000
Expiration Date
1/18/06
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 . .
1/18/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 11.0000
-----------------------------------------------------------------7----------
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 . .
1/18/06
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
1/18/06
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 ONLY. ALARMS/BARRIERS
SHALL
LQPERMIT
Application Number . . 05-00003152
----------------------------------------------------------------------------
Special Notes and Comments
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged
----------------- ----------
Permit Fee Total 311.00
Plan Check Total 160.55
Grand Total, 471.55
LQPERMIT
Paid Credited
00 .00
00 .00
00 .00
Due
311.00
160.55
471.55
Bin, #
Permit #
p 3� Sz
Project Address: 7�
A. P. Number:
i
Legal -Description:
Contractor:
Address:
City, ST, Zip:
i
Telephone: i `
State Lic. # : L
Arch., Engr., Designer: .
Address!
City, ST, Zip:
Telephone:
---------------
$tate I:ic. #:
Name of Contact Person:
City Of La QUintj
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit APPlication and Tracking Sheer
E eJ 7 l/
v
Telephone # of Contact Person: —,.e3
q Submittal
Plan Sets
t Structural Calcs.
1
Truss'Calcs.
Title V Cales:
Flood plain plan
Grading plan
Subcontactor hist
Grant Deed
II.O.A. Approval
IN I[OUSE:-
Planning Approval
{ Pub.11'ks. Appr
if School Fees
APPLICANT: D
Req'd Recd
Plan Check s
Reviewed, rei
Called Conta
Plans picked
Plans resubm
2" Review, n
Called Conta
Plans picked
Plans.resubm
s°' Revie
Called Conta
Date of perni
Owner's Name:
Address: .O
VIA
City, ST, Zip:
Telephone: C
Project Description:
y
f
Construction Type: Occupant:':
Projecttype (circle one) ew Add Alter Repair Demo
Sq. Fl.: L st�. # Stories.# Units;.
Estimated Value of Project:�%� 0
NOT WRITE BELOW THIS LINE
TRACKING' PERMIT FEES :
ibmitted
2J
Item
Amount
dy for corrections
Plan Check Deposit
A Person
Plan Check Balance
1p
Construction
fitted
h4chanical
ady for correctionsfissue
Electrical
I Person
Plumbing
ap
S.11I.1. '
fitted
Grading
tdy for corrections/issue
Developer lmpAcl Fee
:l Person
4issuc
Total Permit Fees