08-1445 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
0707 _ 01445—�
Property Address:
52965 HUMBOLDT BLVD
APN:
767-200-091-4 -34968 -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
40000
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
--------------------------------------------------
!LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
.License Class: C53 License No.: 614611
_. �w ctor:
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).:
(_) 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 (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:
c
LQPERM[T
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/20/08
Contractor: IFE u
MCINTYRE POOLS & SPAS, INC. g
LiC. NO.::614611 ,
83695 AVENUE 45 AUG 21 2000
INDIO, CA 92201 '
( 760) 3423612 CITY OF LA QUINTA
------------------
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.
K 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 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.
1'15ate
WARNING: FAIL(TRE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 and5punty ordinances and state laws relating to building construction, and hereby authorize representatives
of thi ounty to en r upo he above-mentioned property for inspection p poses.
ate: gnature (Applicant or Agent):IV—
.9.
Application Number 1 08-00001445
Permit ...
BLDG POOL PERMIT
Additional desc
Permit Fee . . . .
349.50 Plan Check Fee
227.18
Issue Date . . . .
Valuation . . .
. 40000
Expiration Date
2/16/09
Qty Unit Charge
Per
Extension
BASE FEE
252.00
15.00 6.5000
----------------------------------------------------------------
THOU BLDG 25,001-50,000
97.50
Permit
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
2/16/09•
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
---------------------------------
EA MECH FURNACE >100K
--------------=--------------------------
-------------------------------------------
11.00
Permit(.. . . .
Permit( ..
ELEC POOL PERMIT -RES
Additional desc .
` Permit Fee . . . .
45.00 Plan Check Fee
11.25
Issue Dale . . . .
Valuation
0__
Expiration Date
2/16/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
--------------------7-------------------------------------------------------
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
2/16/09
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
----------------------------
Notes and Comments
POOL/SPA, WATER FEATURE & 70 L.F. OF
LQPERMIT
LQPERMIT
t
Application Number . . . . 08-00001445
--------------------------------------------------------------------
Special Notes and Comments
1'1'2" GAS LINE FOR APPROVED FIREPIT.
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. EQUIPMENT
ENCLOSURE NOT INCLUDED.
Fee summary Charged Paid Credited Due.
Permit Fee Total 453.50 .00 00 453.50
Plan Check Total 253.18 .00 .00 253.18
Grand Total 706.68 .00 .00 706.68
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Bin #
City of La Quints
Building at Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # ✓
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Project Address: 5'l (J RUM h�
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Owner's Name: mcxhlsad ,
A. P. Number:77R lyU
Address: C a
Legal Description:
Contractor: C 5 5 S?L
Address: Llie '4S
City, ST, Zip:il
Telephone: x
Project Description:
City, ST, Zip: C`
-OWN
S 0 1�-
Telephone: 4 1 -3611s
i
State Lic. # : G City Lica #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:L
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person: a 5 G - 6
Estimated Value of Project: Lf 0 , ocry
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
11/a
a
Item
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
2nd 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:-
''d 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