11-0472 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: ri1-000004.72
Property Address: 52825 HUMBOLDT BLVD
APN: 767-880-014- -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 28890
T4i!t 4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
Contractor: .
Applicant: Architect or Engineer: 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: 5/11/11
LICENSED CONTRACT,0AIS DECLARATION
I hereby affirm under penalty of perjury that I am Ii nsed unde pr inions of Chapter 9 Icommencing with
Section 7000) of Division 3 of the Business and P assionals ,and my License is in full force and effect.
License Class: C53 L' e e No.: 614611
ate: ontractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of peUI'nessa
m exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Burofessions Code: Anycity or county that requires•a permit to
construct, alter, improve, demolishny 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 Icommencing 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.).
1 _ 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
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 2 0,1'0110 13 9 0 9 7 Z
I certify that, in the performance ofthe wo for whic this rmit is issued, I shall not employ any
person in any manner so as to become bject to Oe w ters' compensation laws of California,
and agree that, if I should become sub' ct to the ork s' compensation provisions of Section
/ 3700 of th Labor Code, I shall forth ith comp wi those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WO ERS' C MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMIN PENA IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION T COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, REST, 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 w is not commenced
within 180 days from date of issuance of such permit, r cessatioV or 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above i rmation is agree to comply with all
city and county ordinances and state laws relating to building con ruction, a thorize representatives
of this county to enter upon the above-mentioned property for i pection p o
Date:ignature (Applicant or Agent):
Application Number .
. . . . 11-00000472
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
-----------------------------------------------------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
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
. . . . .. 11-00000472
---------------------------------
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
LQPERMIT
Bin #
qw
City of La ulnta .-
Q
:Building & Safety -Division
P.O. Box 1504, 78-49S Calle Tampico
U Quints, CA 92253 - (7¢0) 777-7012
Building Permit Application and Tracking Sheet
Permit # ^
1
Project Address;*6 _
Owner's Name:
A. P. Number:
Address: cjn IC/
Legal Description: go'
!
City, ST, Zip: (01f i Y7 JQ Cf'• 22
Contractor:
Address: 3 , At
�0j
-6
Q
Telephone:
Project Description:.
I
City, ST, Zip:. l.Ci' •
`7G2O 1 .
.9220
Telephone: Z=:MM
11 Y
`
State Lie. # : - 6City
Lic. #:.
Arch., Engr., Designer.-
esigner:Address:
Address,
City, ST, Zip:
Telephone:
Stafe Lit. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n `Alter ' Repair Demo
Name of Contact Person:
i
e f
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person:
76 CF
Estimated Value .ofProject:
APPLICANT: DO NOT WRITE BELOW THIS UNE .
N
Submittal
Req'd ,
Rec'd
TRACMG .
PERMIT FEES '
Plait Sets
Plan Cbeck 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
Gradingplan'
2°" Review, ready for correctioreiissue
Electrical
SubcontactorList
Called•Contact Person
Plumbing
Grant'Deed
Plan's. picked up
SIMI.
H.O.A. Approval
Plans resubmitted
Grading.
IN HOUSE:
Jnd 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 Permit Fees