11-0574 (RPL)1
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: x.11-00000574 J
Property Address: C-52805-HUMBOLDT BLVD
APN: 767-880-015- -
Application description: POOL _ RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 29850
Applicant:
-
---------- - - - - - - - -
I hereby affirm under penalty of perjury that I
Section 7000) of Division 3 of the Business a
License Class: C53
mate: %- � - tl ontractor:
/ OWNER -BUILDER DECLARATION
I hereby affirm under penalty of per ry that I a exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Bus ass and P fessions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, r repair a y structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that a or sh is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing ith S tion 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and sis 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$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 _ 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
T4&t . 44,Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
D�e
pntractor:
Architect or Engineer: IINTYRE POOLS & SPAS, INC.
�1� Q 2U 11 1 695 AVENUE 45
(�
IO, CA 92201
\�N Gl'fyOP56AOS,I2WA ( 60)342-3612
LJLC. No.: 614611
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/02/11
- - - -r 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - —
ED CONT CT R'S DECLARATION
licensed'u der rovisions of Chapter 9 (commencing with
'rofession Is Che, and my License is in full force and effect.
Lice se No.: 614611
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: I1J �,
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.
x I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for whi is permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier GOLDEN EAGLE IN lbome
]icy Num er 010010139097Z
I certify that, in the performanca work f r whi h this permit is issued, I shall not employ any
person in any manner so as tsub act to he workers' compensation laws of California,
and agree that, if I should besubject o the workers' compensation provisions of Section
3700 of the L or Code, ] shhwit om y with those provisions.
Date: �' p]icant:
WARE TO SECURE W RS' COMPEN ATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI NAL PEN LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDI ION TO TH COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR ODE, INTE EST, AND ATTORNEY'S FEES. .
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereb made t the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth t ' application.
1. Each person upon whose behalf this application is made, each person whose request and for
whose benefit work is performed under or pursuant to any permit i u as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, in,
n m ify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or o issi n related to the work being
performed under or following issuance olicf this permit.
2. Any permit issued as a result of this appation beco as null a d v id if work is not commenced
within 180 days from date of issuance of such per it, or ces ati of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above mforma ion is correct. I agree to comply with all
city a county ordinances a state laws relating to building co structi , and hereby authorize representatives
of is county to enter up the above-mentioned property for i pecti purposes.
Date: � ignature (Applicant or Agent): l
Application Number . . . . . 11-00000574
.. Permit . . .
BLDG POOL PERMIT
Additional desc .
• Permit Fee . . . .
284.50 Plan Check
Fee
184.93
- Issue Date . . . .
Valuation
. . . .
29850
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
Application Number
. . . . 11-00000574
- --------------------------------------------------------
Special Notes and
Comments
-
PLACE AT PRE -PLASTER
INSPECTION.
,
_ EQUIPMENT ENCLOSURE
NOT INCLUDED. 2010
k
CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . BLDG STDS ADMIN (SB1473)
2-.00
Fee summary
Charged Paid
Credited
Due
Permit Fee Total
- - -
388.50 .00
---------- ----------
.001.
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 #
low
City d a Q. uinta .
Building u Safety -Division
P.O. Box 1504, 78-495 Calle Tampico
La Quilita, CA 92253 -'(7¢0) 771-7012-
77-7012Building Permit Application and Tracking Sheet
Building
Permit #
��
Project Address; �2_ 5
Owner's Name:
t
A. P. Number:
Address: _ hLm
b Q 1. o
Legal Description: 0 n�
Contractor: ✓
C � / S
Address: As.
City, ST, Zip: C CA ,
Telephone:
Project Description:.
G cJ
City, ST, Zip:, o L2
Telephone: 34 2_ 36: -2
Matyyic.
State Lie. # : C-513— 61 1% 11
#:.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: O;pncy;
SWe Lit. #:
Project type (circle one): New Add'n "Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value.ofProject:
APPLICANT:
DO NOT WRITE BELOW THIS UNE .
#
Submittal
Req'd ,
Rec'd
TRACIMG
PERMTT 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' .
2od Review, ready for correctiorisrssue
Electrical "
Subeontactor. List
Called"Contact Person
Plumbing
GranfI?eed
Plans. picked up
S.M.I.
A.O.A. Approval
Plans resubmitted
Grading .
IN ROUSE:
''d Review, ready for correctionVissue
Developer Impact Fee
Planning Approval '
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
POOLS & S PAS
w
1
v
a
Di rift G
a