05-1673 (RPL)BuiLDING & SAFETY DEPARTMENT
P.O.- Box 1504
(7'60).,7.7.7-.71012
OF 78-495 CALLE TAMPICO '(760 . )-777-70Y.1
FAX
QUINtA, CAL IFORNI . A 92253 INSPECTION REQUESTS (76.0) 777-7153
BUILDING PERMIT
M AY 042005
I �IW "IA o -ber 05-0 . 0001673 Date 5/ . 0 3/05
.w ,,�km
04on M
FMANOW".-A 55375 TURNBERRY WY
ss
APN: 7 67 0 04 -
Application description.-. POOL RESIDENTIAL
Property Zoning'.. LOW DENSITYRESIDENTIAL
.Application'valuation' . . . . 200*00
Ownor Contractor
---------- ------------ - ----------------------------------
SWC.NORMAN 39
MCINTYRE POOLS & SPAS, INC.
CJO DAVID PEERY WCC:'* STATE FUND
INDIANAIAVE WC: .1769111 01/-01/06
RIVERSIDE,- CA 92504t CSLB: 61461�1 09/30/05.
CCC: C53
-------------------------- ------------ -------------------------------- ---------- -
P.O. Box 1504 VO`10E (760) 777-7012
7�495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0��- 16 Q - I . Date: S- 54--0 —�
Applicant:
Applicant's Mailing Address:
Q,
'01V77
C e4 & —vo, C
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
/V�+
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions %Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Licppxp is i and effect.
V/_
License License No4� 1 (4),
_�V 0 T
W(e ContractoJa/_AQ_L\_J�
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 7QOO) 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 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 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 reasori
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 .
of the work for which this permit is issued. .-elf-insure for workers' compensation, as provided for by Sectio'n 3700 of the Labor Code. for the performance
XI have and �q maintain workers' compensation in&ir . ance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
0hy 40rrrs' compensation insurance me !=rtre,
Policy N
'�e r umbe,
I chrtify that, in the performance of the work for v hi:;h this permi't is%tudd, 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 Code, I shall
forthwith comply with those provisions.
Applicanj�--_2A4��O,
WARNING: FAILURE TO SECURE WORKERS'COMPENSATJON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS C$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.).
Lendees 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
issue * d as a result of this application, the owner, and :he 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 undero'r 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 e I pon the above-mentioned propVy for inspection purposes.
Date
Signature (Applicant or Agent)
----------------------------------------------------------------------------
Application Number . . . . . 05-00001673
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Permit . . . . . . -BLDG POOL PERMIT
Additional desc
Permit Fee . . . . 207.00 Plan Check Fee 134.55
Issue Date . . . . Valuation . . . . 20000
Expiration Date.. 10/29/05
Qty Unit Charge Per Extension
BASE FEE 45.00
18.00 9.0000 THOU BLDG 2,001-25,000 162.00
-------------------------------------------------------------------------
Permit I . . . . . MECH POOL
Additional desc
Permit Fee . . . . 26.00 Plan Check'Fee
Issue Date . . . . Valuation . . . . 0
Expiration Date 10/29/05
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA ' MECH FURNACE >100K 11.00
------------------------------------------ 7 ----------------------------------
Permit . . . . . . ELEC POOL PERMIT -RES
Additional desc
Permit Fee . . . . 45.00 Plan Check Fee 11.25
I ssue Date Valuation . . . . 0
'Expiration..Date 10/29/05
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 10/29/05
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
----- -----------------------------------------------------------------------
Special Notes and Comments
POOL & SPA ONLY. ALARMS/BARRIERS SHALL -
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Pe rmit Fee Total 311.00 .00 .00 311.00
Plan Check Total 160.55 .00 .00 160.55
Grand Total' 471.55 .00 .00 471.55
Total Permit Fees
Bin,#
City of La Quinta
Building a Safety Division
Permit #
P-0. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit ApPlication and Tracking Sheet
X
Project Address:
r,.4 V-�Q
Owner's Nam
Owner's �=
A. P. Number
EAddress: 7 S-- 7-,k*1 AJ 6,0-c r
Legal Description:
Ci ST
City. ST. Zip:
Contractor:
—14)
Address: �k -� -
L
;Telephone: ----
XProject
Description:
X
City, ST, Zip:
C)
1K
Telephone: -�c (3 k 731
%
_PCY (P
A
State Lic. # : (0 1 Q
Ciry Lic. #:
Arch., Engr., Designer:
Address:
City. ST. Zip:
Telephone:
—7—
Construction Type: Occupancy:
State Lic. #:
A
Project tYPc (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
X
Telephone # of Contact Person: <:Z,-1
V
q x 115 -2
Stories:
I
Knimatcd Value Pro
# Units:
of iect: 0
APPLICANT: DO NOT WRITE BELOW THIS LINE
11
Submittal
Reqld
Rec'd
TRACKING
Plan Sets
PERNIIT FEES
Plan Check submitted
Item
Structural Cales.
'11
Reviewed. readv for corrections
-------------
Amovat
Truss Caics.
Plan Check Deposit
Called Contac t Person
Plan Check Balance
Energy Calcs.
.
Plans oicked up
-------
Flood plain plan
Plans resubmitted
Construction
Grading plan
Z" Review. ready for corrections/issue
Mechanical
Subcontactor List
Called Contact Person
Electrical
-----------------
Grant Deed
Plumbing
Plans picked up
H.O.A. Approval
Plans resubmitted
IN HOUSE:-
Review, rcadv for correctionstissue
—
Grading
---------
Planning Approval
Developer Impact Fee
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
I
Date of permit issue
School Fees
I
Total Permit Fees
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................................ .......
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