07-2870 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO f
LA QUINTA, CALIFORNIA `92253
13 Application Number:
Property Address:
APN:
Application.description:
Property Zoning'
Application valuation:
Applicant:
T4ht 4 4a "
\� BUILDING & SAFETY' DEPARTMENT
07-00002870
53517 -VIA BELLAGIO
772-510-047- - -
POOL RESIDENTIAL
LOW DENSITY RESIDENTIAL
25000
Architect or Engineer:
014
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with
Section 7 001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
'ice,
ice se ass: C53 License : 614611
at,actor.
OWNER -BUILDER DECLARATION
1 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 1$5001.:
I _ 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.).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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:
LQPERA11T
Owner:
SEDONA HOMES
49-950 JEFFERSON ST
INDIO, CA 92201
Contractor:
MCINTYRE POOLS & SPAS,
83695 AVENUE 45
INDIO, CA 92201
(760)342-3612
Lic. No.: 614611
VOICE (760) 777-7012
FAX (760) 777-70'11
INSPECTIONS (760) 77777153
� 4
ate: 0/07
o Nov 05 1001ti
Nov 0 7
n' OF
22A_kEA�,N1q
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 MAJESTIC INS CO Policy Number C20060333602
_ 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
3700 of the Labor C e, shall fon with compl withAthose provisions.
�"' . A ' ant: � �Q ,A.� .
WARNING: FAIL RE 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 tobu' ding construction, and hereby authorize representatives
of�Counter above-mentioned pr, r ina -spectio pu poses.
Da .Si ure upon.the (Applicant or Agent):
Application Number . . . . . 07-00002870
Permit . . . BLDG POOL PERMIT INV FEE
Additional desc .
J Permit Fee . . . . 504.00 Plan Check
Fee
163.80
Issue Date . . . . Valuation
25000
Expiration Date 4/27/08
Qty Unit Charge Per
Extension
BASE FEE
90.00
23.00 18.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
414.00•
Permit . . . MECH POOL
Additional desc .
Permit. Fee 26.00 Plan Check
Fee
6.50,
Issue Date . . . . Valuation
. . .
. 0
Expiration Date'. 4/27/08
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 4/27/08
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 4%27/08
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
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA,'WATER FALL. ALARMS/BARRIERS
LQPERMIT
Application Number . . 07-00002870_
------------------------------------------------------------ ------------
Special Notes and Comments
SHALL BE IN PLACE AT PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOTLU
INCLUDED. INVESTIGATION FEE ASSESSED PER
T 1997.UNIFORM ADMINISTRATIVE CODE §304.5
FOR WORK BEGUN WITHOUT BUILDING PERMIT.
Fee summary- Charged Paid Credited Due
----------------- ---------- ---------- -------- 7- ----------
Permit Fee Total 608.00 .00 .00__ 608.00 .
Plan Check Total 189.80 .00 .00 189.80
Grand Total 797.80 .00 .00 797.80
LQPM11T
Bin #
C( of L •
City a Qu(nta
Building at Safety Division'
P.O. Box'1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012 : `F
Building Permit Application and Tracking Sheet.
Permit #
Project Address:5 3 — Zellbarieb
Owner's Name: S S
A. P. Number:
Address: q-
Legal Description:
City, ST, Zip: �v y �� • CA-
Contractor: C
S 1170.
Telephone:
rw
r
Address:_ v e- ,5
Project Description:
City, ST, Zip: C
Telephone: 1
6 i`
State Lic. # : 61110 City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: ? - P�
State Lic. #: r r
Name of Contact Person: j ke— L
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: U
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING •
PERMIT FEES
Plan Sets
Plan Check submitted
l
Item 1
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical,
Grading plan
tad 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:
'"' Review, ready for corrections/issue '
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.'
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees