08-0546 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
PIA
LICENSED CONT CTOR'S DECLARATION
hereby affirm under penalty of perjury that I am Ii nsed er provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and P ofessi Is Code, and my License is in full force and effect.
License Class: C53 License No.: 614611
Dater tractor.
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 1, 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.). ,
( ) I ani 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/02/08
Owner:
SHERLOCK
81910 SEABISCUIT WAY
LA QUINTA, CA 92253
,(760)777-9920
Contractor:
MCINTYRE POOMC11X�t.ktR0CUW1tT
83695 AVENUE
INDIO, CA 92
(760)342-361
Lic. No.: 61 �.
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
Code, for the performance of the work for which this permit is issued. 'My workers' compensation
insurance carrier and policy number are:
Carrier DELOS INS CO Policy Number 01DKRM12001870
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 becom bject to the workers' compensation laws of California,
and agree that, if I should come s t to the workers' compensation provisions of Section
/377000 'offtthe Labor Code shall f ith comply with those provisions.
ate: ' V !_ Applicant:
WARNING: FAILURE TO SECU 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 ab in
s correct. I agree to comply with all
city and county ordinances and state laws relating to buildin nor
hereby authorize representatives
ofthi"iK,
upon eabove-mentioned property inspe irposes.
Uate: ature (Applicant or Agent)'
0
Application Number:
-00000546
Property Address:
81910 SEABISCUIT WY
APN:
767-200-999-34 -312023-
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:.
27000
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
PIA
LICENSED CONT CTOR'S DECLARATION
hereby affirm under penalty of perjury that I am Ii nsed er provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and P ofessi Is Code, and my License is in full force and effect.
License Class: C53 License No.: 614611
Dater tractor.
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 1, 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.). ,
( ) I ani 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/02/08
Owner:
SHERLOCK
81910 SEABISCUIT WAY
LA QUINTA, CA 92253
,(760)777-9920
Contractor:
MCINTYRE POOMC11X�t.ktR0CUW1tT
83695 AVENUE
INDIO, CA 92
(760)342-361
Lic. No.: 61 �.
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
Code, for the performance of the work for which this permit is issued. 'My workers' compensation
insurance carrier and policy number are:
Carrier DELOS INS CO Policy Number 01DKRM12001870
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 becom bject to the workers' compensation laws of California,
and agree that, if I should come s t to the workers' compensation provisions of Section
/377000 'offtthe Labor Code shall f ith comply with those provisions.
ate: ' V !_ Applicant:
WARNING: FAILURE TO SECU 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 ab in
s correct. I agree to comply with all
city and county ordinances and state laws relating to buildin nor
hereby authorize representatives
ofthi"iK,
upon eabove-mentioned property inspe irposes.
Uate: ature (Applicant or Agent)'
LQPERMIT
Application Number .
. . . . 08-00000546
' Permit . . . .
BLDG POOL PERMIT
Additional desc .
Permit.Fee . . . .
265.00 Plan Check Fee
172.25
Issue Date . . . .
Valuation
26760
Expiration Date
9/29/08
Qty Unit Charge
Per
Extension
BASE FEE
252.00
2.00 6.5000
-----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
13.00
Permit . .
MECH POOL
Additional desc ..
Permit Fee
26.00 Plan Check Fee
6.50_ .
Issue Date . . .
Valuation
0
Expiration Date
9/29/08
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
9/29/08
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
9/29/08
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
Permit . . . . . .
WALL/FENCE PERMIT
LQPERA1JT
Application Number . . . 08-00000546
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee 15.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
240
Expiration Date 9/29/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA, 15 L.F. 4' EQUIPMENT WALL,
CITY STANDARD. ALARMS/BARRIERS SHALL BE -
IN PLACE AT PRE -PLASTER INSPECTION.
Fee summary Charged Paid Credited
Due
Permit Fee Total 384.00 ..00
.00
384.00
Plan Check Total 198.25 .00
.00
198.25
Grand Total 582.25 .00
.00
582.25
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Bin #
City of La. Quints
:Building u Safety Division '
Permit #
5
P.O. Box 1504, 78-495 Calle Tampico
La Quilita, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:'8 _ /O s
it
Owner's Name:
A. P. Number:
Address:.81. O S 1
T
Legal Description:
City, ST, Zip: Jct a. uo 5
Contractor -
A! TA i4fe.
L.k
Telephone:
_
Address: 3 -6 KA
:ProjectDescription:. S
b
City, ST,Zip:. ° .60.
Zt? 0
12
Telephone: 3 ¢ Z
Td 'T
State Lie. # :
City Lie. #:.
y1'I
Arch., Eng., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
P cy:
State Lit. #: C'S 3 — 614611'_,Project
type (circle one): New Add'n ' Alter Repair Demo
Name of Contact Person: e f
Sq. FL:
#_ Stories:..
[# Units:
Telephone # of Contact -Person: '
Estimated Value.of Project: 7
APPLICANT: DO NOT WRITE BELOW THIS LINE .
#
Submittal
Req'd
Recd
TRACMG .
PERMTr FEES
Plan Sets
Plan Check submittedItem
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit .
Truss Cities.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan ,
Plans resubmitted
Mechanical
Grading, plan
tad Review, ready for correctiorisrissue
Electrical
Subcontactor.List
Called Contact Person
Plumbing
GranfDeed
Plans. picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading.
IN HOUSE:-
''" Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P:
'
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
�a7OOO
r
a�-7