05-3563 (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:
0500003563 _
51667 VIA BENDITAk?
772-270-010-9 -311231-
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000
Architect or
kl�
T4'y
4vQ"
BUILDING & SAFETY DEPARTMENT
. BUILDING PERMIT
---------------------------------------------------
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.
Licen ass:/ License No.:
at Contractor,! - l P60 �S
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 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.).
(_ I 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:
HILL
51-667 VIA BENDITA
LA QUIN TA, CA 92253
Contractor:
MCINTYRE POOLS & SPAS,
WCC: STATE FUND
WC: 1769111
CSLB: 614611
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
INC.
01/01/06
09/30/05
Date: 8/11/05
-----------------7-----------------------------
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
T 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 subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3 0 of the Labor _Co s lI ffoo�rth�wiithh comply with those provisions. _
te: Applicant: :f—
V T V ► \ / l�`-�
WARNING: FAILURE 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 c unty ordinances and state laws relating to buildin onstruction, and hereby authorize representatives
of t c my to enter upon the above-mentioned prope y fo '-spection purposes.
e Signature (Applicant or Age 1:
Application Number . . . . . 05-00003563
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
207.00 Plan Check Fee
134.55
Issue Date . . . .
Valuation . . .
. 20000 -
Expiration Date
2/•07/06
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
2/07/06
y
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
2/.07/06
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
2/07/06
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
LQPERMTT
Application Number• . . . . . 05-00003563
----------------------------------------------------------------------------
Special Notes and Comments.
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid
----------------------=--------------
Credited
--------------------
Due
Permit Fee Total. 311.00 .00
.00
31.1.00
Plan Check Total 160.55 .00'
.00
.160.55
Grand Total 471.55 .00
.00
471.55
LQPERMIT
DATE) Of BY
JET PUMP 0 w
DECK AREA 65150. fr
PAVED AREA
W.F.
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wo
i28''6'
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7'X7'
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MANURE
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CONSM cna+s�causr"
I342-3612
I
PAW
r
a A
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.'
POOL SIZE 28'-6" X 25'
POOL S.A. 379 50. ff.
I
I
• • ' '
POOL PER. 102 ff
I
• •
: .,
DEPTHS TO y'
.
POOL PUMP P. N,p.
I
I
"�'�R q0°,� mHILL
RESIDENCE
.
MLTER crn 420
LOT # 9 LA CANTERAMOOWAff
LIGHTS 2.100 WAff
LA QUINTA, CA,
CONTROLLER
I
`
SPA SIZE
I
SPA PER. 28' L . K.
I
SPA S.A. 19' 50. ff,
I
SPA DEPTH
I
JET'S y
I
DATE) Of BY
JET PUMP 0 w
DECK AREA 65150. fr
PAVED AREA
W.F.
Permit #
01-
Project Address:*
A. P. Number:
Contractor: X i;_-11
Cin•. ST. Zip: y, 14 �i
Telephone: X _� <
State Lic. #
Arch.. Engr.. Designer:
Address:
City. ST. Zip:
Telephone:
State Lic.:
Name of Contact Person: x
Telephone # of Contact Person:
o Submittal
Plan Sets
Structural Caics.
Truss Caics.
Title 24 Caics.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78.495 Calle Tampico t
Building
La Qulnta, CA 92253 - (760) 777-7012
Permit Application and Tracking Sheet
1 Owner's Name: X'1
Address:
City ST. Zip: K
/ Telephone:
Project Description:
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd TRACKING
Plan Check submitted
Reviewed, ready for corrections
Called Contact Person
Plans picked up
Plans resubmitted
2n° Review, ready for corrections/issue
Called Contact Person
Plans picked up
Plans resubmitted
3'd Review, ready for corrections/is ue
Called Contact Person
Date of permit issue
PERMIT FEES
Item
Plan Check Deposit
Plan Check Balance
Construction
Mechanical --
Electrical
Plumbing
SAM,
Grading
Developer Impact Fee
A.I.P.P.
Total Permit Fees
Amount