12-0592 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4Qumfw
BUILDING & SAFETY DEPARTMENT
BUILDING.PERMIT
Application Number:12-000.OA5,9.2��
Property Address: 8-03-95 CCAAMARILLO WY
APN:. 777-330-036- -
Application description: REMODEL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2800
Applicant:
Architect or Engineer:
LICENSED ONTRAC'
.I hereby affirm under penalty of perjury that I am lic sed and
Section 7000) of Division 3 of the Business and Pr f ssional C
Li c 'se Class: C53 c
Date:a—Z-Q17 Co ractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjry tha am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Busi nd 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 fora 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 -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
1—) 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 am exempt under Sec. , B.&P.C. for this reason
0kf�-
----------------------
-S DECLARATION
visions of. Chapter 9 (commencing with
, and my License is in full force and effect.
No.: 614611
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:
DZIAKYK GLEN
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/29/12
Contractor:
MCINTYRE POOLS & SPA D L
NC.
83695 AVENUE 45 r'�.1
INDIO, CA 92201
(760) 342-3612 EMAY 9 2012
Lic..No.: 614611
CITY OF LA QUINTA
FINANCE DEPT.
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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.
,have and will maintain workers' compensation insurance, as eq red by Section 3700 of the Labor
Code, for the performance of the work f which this p is issued. My workers' compensation
insurance carrier and policy number are
Carrier COMMERCE WEST I Polic umber 3 0843590
I certify that, in the performance of th ork.for wh' h t s permit is issued, I shall not employ any
person in any manner so as to be a subject t workers' compensation laws of California,
and agree that, if I should becom subject t e orkers' compensation provisions of Section
3700 of the Labor Code, I shallAbrthwith� with those provisions.
i
WARNING: FAIL RE TO SECVE=S' COMPENSATION COVERAGE ISUNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TONALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOREST, 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 an oid if w is of commenced
within 180 days from date of issuance of such permit, or cess ion of w rk f 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above informs on is co ect agree to comply with all
city and county ordinances and state laws relating to building construct n, and re authorize representatives
of this county to enter upon the above-mentioned property for inspect n purp e
Sign re (Applicant or Agent
Application Number . . . . . 12-00000592
Permit . . . ELECT - ADD/ALT/REM
` Additional desc .
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date Valuation
0
Expiration Date 11/25/12
Qty Unit Charge Per
Extension
` BASE FEE
15.00
4.00• .7500 PER ELEC DEVICE/FIXTURE 1ST 20
----------------------------------------------------------------------------
3.00'
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date . . Valuation . . .
. 0
Expiration Date 11/25/12
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
MOVE EXISTING. POOL EQUIPMENT TO NEW
LOCATION TO ACCOMODATE NEW ROOM
ADDITION. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------
Due
-----------------------------------------------
Permit Fee Total 36.00 .00 .00
36.00
Plan Check Total 9.00 .00 .00
9.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 46.00 .00 .00
46.00
LQPERMIT
ef».#
City Of La Qurnta
Bullft 8[ Safety Dlvlslon
P.O. Box 1504,-78-495 Caffe Tamploo
U.Quinta, CA 92253 - (7b0) 777-7012
Building Pennit -Application' and Tracking Sheet
Perinit #
Project Address:combf;lln
Owner's Name: en.2eil','d
A P. Number.
Address: So
Legal Description:
City, ST, Zip:
Colftwwr.Y
0M I
'
Telephone:
Address' 3 - S 4
Project Description:
City, ST, Zip:
Telephone: Z — 36 �*'
State Lia #: T S - City Lic. #,
ArdL, Eng., Designer.
Address:
City, ST, Zip.
Telephone:'
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lia #:
Name of Contact Person: C fY V
Sq. Ft.: # Stories:
# Unity:
Telephone # of Contact Person:�.
Estimated Value of Project �j ----
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Rcq'd
Recd
TRACMG PERMITFEES-
Plan sets
Plan Cheek submitted item Amount
Structural Cales.
Reviewed, ready for corrections Pian Check Deposit • .
Truss C21cs.
Called Contact Person Plan Check Balance.
Title 24 Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted.. Mechariitai
Goading plan
2'! Review, ready for correctionsfissue Electrical
Subeontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.1VLL
H.O.A. Approval
Plans resubmitted Grading
El HOUSE:-
''' Review; ready for eorrections/issac Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees