05-3977 (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:
e_ -0:5:_D0 0.0_0 30.0_0
80290 VIA CAPRI
772 -440 -073 -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000
T,&t 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
SEP 15- 2005
-------------------------------------
LICENSED CONTRACTOR'S. DECLARATION FIPIAIV(
1 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.
License Class: License No.:
Date: Contractor:/s%';i//!
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
( P 1 9 1 1
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.).
( 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:
LQPERMIT
Date: 9/13/05
---- ----------------------------------------
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
t/ issued.
^ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
i 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
J/ 37 0 of the Labor Code, I shall forthwith comply with those provisions.
tD3 e: Applicant: �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 coun y ordinances and state laws relating to building,construction, an hereby authoriz epresentatives
of this o*5Zo_�Isignature
unt to a ter upon the above-mentioned property or in n ose
Date: (Applicant or Agent): 7
Owner:
ALBERS
80-290 VIA CAPRI
LA QUINTA, CA 92253
Contractor:
MCINTYRE POOLS & SPAS,
INC.
n
a Inl
WCC: STATE FUND
WC: 1769111
01/01/06
[ti
CSLB: 614611
09/30/05
SEP 15- 2005
-------------------------------------
LICENSED CONTRACTOR'S. DECLARATION FIPIAIV(
1 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.
License Class: License No.:
Date: Contractor:/s%';i//!
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
( P 1 9 1 1
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.).
( 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:
LQPERMIT
Date: 9/13/05
---- ----------------------------------------
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
t/ issued.
^ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
i 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
J/ 37 0 of the Labor Code, I shall forthwith comply with those provisions.
tD3 e: Applicant: �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 coun y ordinances and state laws relating to building,construction, an hereby authoriz epresentatives
of this o*5Zo_�Isignature
unt to a ter upon the above-mentioned property or in n ose
Date: (Applicant or Agent): 7
Application Number . . . . . 05-00003977
Permit
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
207.00 Plan Check Fee
134.55
Issue Date . .
Valuation . . .
. 20000
Expiration Date
3/12/06
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
3/12/06
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
3.75
Issue Date . . . .
Valuation
0
Expiration Date
3/12/06
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
3/12/06
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
ti
LQPERMIT
Application Number . . . . . 05-00003977
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 .00 311.00
Plan Check Total 153.05 .00 .00 153.05
Grand Total 464.05 .00 .00 464.05
LQPERMIT
in g
City Of La Quints
Building Mr Safety Division
Pe it
P.O. Box 1504, 78.495 Calle Tampico
3 a
ate` `
La Quinta, CA 92253 - (760) 777.7012
Building Permit �APPlication and Tracking _ ckmg Sheet
Project Address:
'
Owner's Name: X
A. P. Number:
11
Address: X b _
Legal Description:
City, ST, Zip: X
Contractor: K( G
�- Telephone:
Address:
Project Description:
C4. ST. Zip: Y Ji 4\�
�c
Telephone: X �.. -�
C
State Lic. # : x, o L
City Lic. #:
Arch.. Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction st
NCtI• 0 n Type: Occupancy:
State Lic. if:
'> Project typ6 (circle o 11 ne): Ne%%. Add'n Alter Repair DurrName of Contact Person: �( ~
I C 11 -
Telephone # of Contact Person:
Sq. Ft.: # Stories: # Units:
/ "
�,_ �"�'
Estimated Value of Proiect: x caa
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd
Recd TRACKING
Plan Sets
PERMIT FEES
Plan Check submitted
�(
Structural Calcs.
Item Amount
Reviewed, ready for corrections
Truss Calcs.
Plan Check Deposit
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Flood plain plan
Construction
Plans resubmitted
Grading plan
Mechanical
2i° Review, ready for corrections/issue
Subeontactor List
Electrical
Called Contact Person
Grant Deed
Plumbing
Plans picked up
5.111.1.
H.O.A. Approval
Plans resubmitted
IN HOUSE:-
Grading
Review, ready for corrections/isi ue Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
A.I.P.P.
Date of permit issue i:
School Fees
I Total Permit Fees
w