11-0473 (RPL)" -
P.O. BOX 1304
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:11-1 11-00000473�J
Property Address: 2845-HUMBOLDT BLVD
APN: 767-880-013- - -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 28890
Applicant: Architect or Engineer:
T4ht . 4 4Q"
LICENSED
I hereby affirm under penalty of perjury that I am
li
Section 70001 of Division 3 of the Business and P, I
License Class: C53
Date: — ontractor:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
V1 DECLARATION
XXsions of Chapter 9 (commencing with
, and my License is in full force and effect.
No.: 614611
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of p jury that am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Bu iness a Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or rep a any structure, prior to its issuance, also requires the applicant for the
permit. to file a signed statement tha r 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, 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 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:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
3
Date
Contractor:
MCINTYRE POOLS & SPAS,.; J T
83695 AVENUE 45M,! 1
INDIO, CA 92201
(760) 342-3612 CITYAFI.gQu1NU
LiC. NO.: 614611 1 93PJA11Jd%rne!w+
5/11/11
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 24'101110139097Z
I certify that, in the performance of the rk for wh' h thi permit is issued, I shall not employ any
person in any manner so as to beco subject the orkers' compensation laws of California,
and agree that, if I should become bject to vers' compensation provisions of Section
3700 of the Labor Code, I shall f hwith c; ly ith those provisions.
WARNING: FAILURE TO SECUR WORK S"COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI IN PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDIT101TTO 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 ce ion of work f 1 0 days will subject
permit to cancellation.
I certify that I have read this application and state that the above inform ion is correc I a ee to comply with all
city and county ordinances and state laws relating to building constru on, and her y a orize representatives
Of t county to enter upo the above-mentioned property for inspe ion purpose .
ab te: �� ignature (Applicant or Agent):
Application Number .
. . . . 11-00000473,
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . .
278.00 Plan Check Fee
180.70
Issue Date . . . .
Valuation . . .
. 28890 .
Expiration Date
11/07/11
Qty Unit Charge
Per
Extension
BASE FEE
252.00
4.00 6.5000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000,
26.00
Permit
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date
Valuation . . . .
0
Expiration Date
11/07/11
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
11/07/11
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
11/07/11
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
Application Number
. . . . .
11-00000473
----------------------------------------------------------------------------
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
382.00
----------
00
--------------------
.00
382.00
Plan Check Total
206.70
.00
.00
206.70
Other Fee.Total
2.00
.00
.00
2.00
Grand Total
590.70
.00
.00
•590.70
LQPERHIIT
Bin
lawCity ofla Quinta..
Building U SafetyDivision
P.O. Box 1504, 78-495 Calle Tampico
Quinti, CA 92253 - (7¢0) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address.:5 8 IS,
Owner's Name: 1./ O
A. P. Number:
Address:._ B45 Loba V
`legal Description':
.t
.
City, ST, Zip: pan Z�
Contractor:
Address: 3 -.6 5
Telephone:
Project Description:.
t
City, ST, Zip:. h :
00: Z Q I
Telephone: C76
- aG
State Lie. # :
146
City Lic. #:.
Arch., Engt., Designer:
Address:
City, ST, Zip:
Telephone:
State Lid. #:
'Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New AdWri 'Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone #. of Contact -Person:
Estimated Value.of Project- 14Z QQ
APPLICANT:
DO NOT WRITE BELOW THIS UNE .
#
Submittal
Req'd -
Rec'd
TRACKING .
PERMIT FEES'
Plan Sets
Plan Check submitted
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 :
r' Review, ready for correctiolisrssue
Electrical
Subcontactor-List
Called 'Contact Person
Plumbing
Grant'Deed
Planspicked up
SALL
ILO.A. Approval
Plans resubmitted
Grading.
IN ROUSE:
Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
. acl,
mm
190
Im-
eV,
tS
POOL &,SPA SPECS,
POOL SIZE 1qrp-cy
POOL S,A,
POOL PER. Gi
DEPTHS t6 TO S
POOL PUMP US t35
HEATER Ifoo
4 ow
FILTER.01CP
LIGHTS.'
CONTROLLER
SPA SIZE 7
SPA.PER,
SPA S.A. 6,'
SPA DEPTH
JETS
JET PUMP
-----------------
DECK AREA