12-0076 (RPL)t,1 w
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00 0 0 0 076
Property Address:
52765 HUMBOLDT BLVD
APN:
767-200-091-12 -34968 -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
30000
T4bt 4 4v Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
LICENSED NTRACT DECLARATION
I hereby affirm under penalty of perjury that I am lice ed under r isions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pro ssion., ,and my License is in full force and effect.
License Class: �C�5�3 a No.: 614611
Date:/ ✓ 1 ( ontractrerjurythat
/OWNER-BUILDER DECLARATION
I hereby affirm under penalty of m exempt from the Contractor's State License Law for the
following reason (Sec: 7031.5,rofessions Code: Any city or county that requires a permit to
construct, alter, improve, demolystructure, prior to its issuance, also requires the applicant for the
permit to file a signed statemente is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (comment h 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.).
(_ 1 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
Contractor:
MCINTYRE POOLS & SPAS,
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: 1/26/12
3
JAN 35 J 20'x2
EFTY OF 51 1-* 1_NTA
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - —
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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.
V� I have and will maintain workers' compensation insurance, a equired by Section 3700 of the Labor
Code, for the performance of the work for which this p m is issued. My workers' compensation
insurance carrier and policy number ar : .
Carrier COMMERCE WEST I Polic Number 0 3 843590
I certify that, in the performance of the ork for whit thi permit is issued, I shall not employ any
person in any manner so as to beco a subject to a orkers' compensation laws of California,
and agree -that, if I should become s bject to the or ers' compensation provisions of Section
3700 ofthe or Code, I shall fo with cof w h those provisions.
te: - pplicant:
WARNING: FAILURE TO SECUR WORKERS' CPM PEN SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI INAL PENA IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITI N TO TH COST OF COMPENSATION, DAMAGES AS PROVIDED FOR. IN
SECTION 3706 OF THE LABOR CO E, INT EST, 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, indemnity 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 becomeInand void if w k is of commenced
within 180 days from date of issuance of such permit,sation of w rk f 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above infon is corragree to comply with all
city and county ordinances and state laws relating to building constrand he by uthorize representativesofthis countyy to enter upon the above-mentioned property for inspeurpos -
Date: fl- 3- Si ure (Applicant or Agent)',
Application Number .
. . . . 12-00000076
Permit
BLDG POOL PERMIT
Additional desc .
Permit Fee
284.50 Plan Check Fee
184.93
Issue Date
Valuation . . .
. 30000
Expiration Date
7/24/12
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
7/24/12
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
7/24/12
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
7/24/12
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, WATER FEATURE, FIRE PIT.
LQPERMIT
LQPERMIT
Application Number . . . . . 12-00000076
Special Notes and Comments
•ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. EQUIPMENT
ENCLOSURE NOT INCLUDED. 2010 CODES.
----------------------------------------------------- ---------------------------
---- - ----------- - - -
'Other
'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
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CONSTRUCTION SPECIALIST
83-695 Ave. 45 *Indio, CA 922(
D Phone: 760 342-361 ,A
0
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
/�U
Project Address: pC — `76s �lU
Owner's Name: 10 1-s co
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor e �y
z� `??'}
Telephone
Address: S s
Project Description:
City, ST, Zip: T
Telephone: _
State Lic. # : 1 6 ity Lic. #: 5
i
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lic. #:,;4 ' "• •: r ' i r A
Name of Contact Person:
4Estimated
Construction Type: Occupancy:
p y:
project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Value of Project: 0c) "—
APPLICANT:
DO NOT WRITE BELOW THIS LINE
tl
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
20° Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans
S.M.I.
H.O.A. Approval
Plans
Grading
IN HOUSE:
''d Recorrectionstissue
Developer Impact Fee
Planning Approval
opicked
Callen
A.I.P.P.
Pub. Wks. Appr
Date
School Fees
Total Permit Fees