12-0408 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
`Application Number: � X12-00 0 0 04 08
Property Address: 52705 HUMBOLDT BLVD
APN: 767-200-091-15 -34968 -
Application description: POOL RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 34880
Applicant:
-------------------- 1�--
I hereby affirm under penalty of perjury that I
section 7000) of Division 3 of the Business E
License Class: C53 /
Date:41$1( Contractor: _
c&ty/ 4 4 Qulk&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
PA
----------------------
�er
TOR'S DECLARATION
provisions of Chapter 9 (commencing with
ode, and my License is in full force and effect.
License No.: 614611
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury/hat I am exempt from the Contractor's State License Law for the .
following reason (Sec. 7031 f 5, Busin s and Professions Code: Any city or county that requires a permit to
construct, alter, improve, de olish, repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statemen at he or 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).:
(_) 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.).
(_) 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
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 A
Contractor:
MCINTYRE POOLS &
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: 4/16/12
L'
APR 18 2012
ILA M r"' �
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 COMMERCE WEST I Policy umber 330843590
I certify that, in the performance of the ork for is this permit is issued,'I shall not employ any
person in any manner so as to Zbecosubjec to a workers' compensation laws of California,
and agree that, if I should becoect to h-rkers'compensation provisions of Section
3700 of the Labor Code, I shalith y with those provisions.
!Date: �� Applicant:• -
WARNING: FAILURE TO SECU E WORKE ' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO IMINAL NALTIES AND CIVIL FINES UP. TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN AD TION T THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR VqW, 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 nulla d void if work is not commenced
within 180 days from date of issuance of such permit, or ce ation of wo for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above inform Ion is correc I agree to comply with all
city and county ordinances and state laws relating to building construe , and h: a authorize representatives
of this county
((y7yto/�enter upon the above-mentioned property for inspec purpo s.
Date: d -/18—'G Signature (Applicant or Agent)
---
4' -I
Application Number . . . . 12-00000408
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee
317.00 Plan- Check Fee
206.05
Issue Date . . . .
Valuation . . .
. 34880
Expiration Date
10/13/12
Qty Unit Charge
Per
Extension
BASE FEE
252.90
10.00 6.5000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
65.00
Permit . . .
MECH POOL
Additional desc .
' Permit Fee . . . .
24.00 Plan Check Fee
6.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
10/13/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
-------------------------------------------------------------
EA MECH FURNACE <=100K
---------------
9.00
Permit
PLUMBING
Additional desc .
Permit Fee
33.00 Plan Check.Fee
8.25
Issue Date . . . .
Valuation
0
Expiration Date
10/13/12
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 ALARMS, BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER
INSPECTION '
EQUIPMENT ENCLOSURE NOT INCLUDED. 30"
DIAMETER, +18" FIRE PIT 1" GAS RISER.
2010 CODES.
' -----------------_-_-----------------------------------
Other Fees . . .
. . . . BLDG STDS ADMIN (SB1473).
1.00 ,
Fee summary Charged. Paid Credited
Due
Permit Fee Total
374.00 .00 .00
374.00
Plan Check Total
220.30 .00 .00
220.30
LQPERMIT
Application Number 12-00000408
Other Fee Total 1.00 .00 .00 1.00
Grand Total 595.30 .00 .00 595.30
'06
00
0
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9 9 D 1 43 Tw I u
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lb
Bin #
City of La Quinta..
:Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
t Quinta, CA 92253 - (7¢0) 771-7012-
77-7012Building Permit Application and Tracking Sheet
Building
Permit #
Project Address:' Z -ZG,
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: r a 1,J5
Address: _G
ST, ZiP: s 2 0
Telephone:
Project Description:. /�
►,
3G .
r,
[Telephone:
Lie. # : CS 6O
City' Lic. #:.
., Engr., Designer:
ess:
City, ST, Zip:
Telephone:
State Lit. #:
Construction Type: Occupancy:
P cy:
Project type (circle one): New Add'n " Alter Repair Demo
Sq. Ft.: #Stories: #Units:
n
Name of Contact Person:
Telephone #. of Contact Person: 2_ - Z
Estimated Value.of Project: `=
APPLICANT:
DO NOT WRITE BELOW THIS UNE .
#
Submittal
Req'd -
Rec'd
TRACEING .
PEFUWr 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'
2"d Review, ready for correctiotisAssue
Electrical . .
Subcontactor List
Called Contact Person
Plumbing
Granfl)eed
Plans. picked up
S.M.I.
A O.A. Approval
Plans resubmitted
Grading.
IN HOUSE:-
'°i Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
LLTotal
Permit Fees
, %Q