11-0573 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: �711=00000573��
Property Address: l52865_HUMBOL6T BLVD
APN: 767-880-012- - -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 29700
Applicant: 'Architect or Engineer:
UCSE
DONTRAC
I hereby affirm under penalty of perjury that I l' sed under
Section 7000) of Division 3 of the Business and Pr sionals C
License Class: C53
Lion
�Ipr
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
iY nF
rDECLARATION
ons of Chapter 9 (commencing with
and my License is in full force and effect.
No.: 614611
NER-BUILDER DECLARATION
I hereby affirm under penalty of perjuryUhatlexempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Businesessions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or rstructure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that helicensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing wn 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.:
(_ 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 _ 1 I am exempt under Sec. , BAP.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: p(
Lender's Address: `
LQPERMIT
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
Contractor:
MCINTYRE POOLS & SPAS, INC.
83695 AVENUE 45
INDIO, CA 92201
(760)342-3612
LiC. No.: 614611
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/02/11
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 GOLDEN EAGLE IN Policy Number ?010010139097Z
_ I certify that, in the performance oft a work for ch this permit is issued, I shall not employ any
person in any manner so as to b oma subj t t the workers' compensation laws of California,
and agree that, if I should beco subject t workers' compensation provisions of Section
3700 of the Labor Code, I shal orthwith om ly with those provisions.
aD t : *-p ant•
WARNING: FAILURE TO SECUR WORKE ' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TOC MINAL P NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDI ION TO HE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR ODE, ITEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby de 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 . ork is not commenced
within 180 days from date of issuance of suc1permit, r cessation f ork for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the mation i c rect. I agree to comply with all
city and county ordinances and state laws relating to buildition, d ereby authorize representatives
of this county to enter upon the above-mentioned propertyion p p es.
Wt e: 7 -/re (Applicant or Agent):
Application Number .. . . . 11-00000573
Permit BLDG POOL PERMIT
Additional desc .
Permit Fee . . . 284.50 Plan Check Fee 184.93.
Issue Date Valuation . . . . 29700
Expiration Date 11/29/11
Qty Unit Charge Per Extension
BASE FEE 252.00
5.00 6.5000 THOU. BLDG 25,001-50,000 32.50
-----------------------------------------------------------------------------
Permit MECH POOL
Additional desc .
Permit Fee 26.00 Plan Check Fee 6.50
Issue Date Valuation 0
Expiration Date 11/29/11
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... 11/29/11
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 11/29/11
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. ALARMS/BARRIERS SHALL BE IN
LQPERMIT
LQPERMIT
Application Number ^. . . . .
11-00000573
----------------------------------------------
Special Notes and Comments
--------------------------------
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. 2010
CODES.
-
-----------------------------------
'Other Fees . . . . . . . . .
-----------------------------
BLDG STDS ADMIN (SB1473)
-----------
2.00
Fee summary Charged-
Paid
Credited
Due
Permit Fee Total 388.50
-
.00
- ---- -- ----------
.00
388.50
Plan Check Total `210.93
.00
.00
210.93
Other Fee Total 2.00
.00•
00
2.00
Grand Total 601.43
.00
.00
-601.43
LQPERMIT
Bin #
City of LaQ. uinta .
:Building u Safety -Division '
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (7¢0) 777-7012
Building Permit Application and Tracking Sheet
Permit #
�
��" ✓
Project Address:' 2: 865
urn
b 614. 6
Owner's Name: t b n C �CtS
A. P. Number:
Address: 5-2-8-65-' O l . W8
Legal Description:
60
CA
City, ST, Zip:on 4c erA,2 Z
Contractor:AACVY)4Ur*r_16�
Address: 83 _ (�
A5
5
Telephone:
Project Description: .
City, ST, Zip:.
Telephone: (3 42 ' • 361-2
State Lie. # : 3 -
I.
City Lic. #:.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lit. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n 'Alter Repair Demo
Name of Contact Person:
f
r
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact•Person: '
6 �.
Estimated Value.o�Project: 2
700
APPLIC4NT: DO NOT WRITE BELOW THIS UNE .
#
Submittal
Rea
Recd
TRACIMG .
PERMrr FEES
Plan Sets
Plan Checksubmitted
Item
Amount
Structure[ Calcs.
Reviewed, ready for corrections
Plan Check Deposit.
eposit.Truss
Trus sCalcs.
Called Contact Person
-
Plan Check Balance
Energy Calcs.
Plans picked up
'Construction
Flood 'plain plan,
Plans resubmitted
Mechanical '
Grading plan'
214 Review, ready for correctionsrssue
Electrical
Subcontactor-List '
Called'ContactPerson
Plumbing
Granfi)eed
Plans•picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading.
IN HOUSE:
Review, ready for correctionsAssue
Developer Impact Fee
Planning Approval '
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permtt Fees
POOLS & SPAS
it
7n) � �t
MEMO'
i'
!1
DMA,