12-1406 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: _12-000-01406
Property Address: _1525.95 .HUMBOLDT BLVD
APN: 767-200-091-16 _-3'4_§'68 `-
Application description: P06L - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 35600
Applicant:
--------------------
I hereby affirm under penalty of perjury that I an
Section 7000) of Division 3 of the Business and
Lic a Class: C5'3
Date: 1 77 ontractor:-�
• Qum&
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT. INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 12/04/12
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
Architect or Engineer: i'J DE � � 201 nL,INTYRE POOLS & SPAS, INC.
1 yt3695 AVENUE 45
C19'YpF IgvNDIO, CA 92201
-•..��FINANCEpul (760)342-3612
aY Lic. No.: 614611
YS DECLARATION
visions of Chapter 9 (commencing with
, and my License is in full force and effect.
No.: 614611
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perj2ctyison
exempt from the Contractor's State,License Law for the
following reason (Sec. 7031 .5, usfessions Code: Any city or county that requires a permit to
construct, alter, improve, demol h, structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commend 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 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.).
(_) 1 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, s required by Section 3700 of the Labor
Code, for the performance of the wor or which thi� ermit is issued. My workers' compensation
insurance carrier and policy number
Carrier BENCHMARK INS Poli Number W00402
_ I certify that, in the performance of th ork for ' h this permit is issued, I shall not employ any
person in any manner so as to bec a subjec the workers' compensation laws of California,
and agree that, if I should become ubject a workers' compensation provisions of Section
/ 3700JJJof��/the Labor Code, I shall f hwit ply with those provisions.
Date:( 1iplicant:
WARNING: FAILURETOTO SErDITION
ORKERS' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TONAL PEN LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). INA TOT COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABE, INT REST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is here ode 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 es It of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify d hol harmless the City
of La Quinta, its officers, agents and employees for any act or omission r ated t • the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application become/nul nd void i wor s not commenced
within 180 days from date of issuance of such permit,sation o wor or 180 days will subject
permit to cancellation.
1 certify that I have read this application and state that the above infn is rr a . Iagree to comply with all
city and county ordinances an state laws relating to building constrand ere y authorize representatives
f is county to enter t a above-mentioned property for inspeurp es.•
Date:`�� nature (Applicant or Age
1 a
r
Application Number . . . . . 12-00001406
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
323.50 Plan Check Fee
210.28
Issue Date
Valuation
35600
Expiration Date
6/02/13
Qty Unit Charge
Per
Extension
BASE FEE
252.00
11.00 6.5000
-----------------------------------------------------------
THOU BLDG 25,001-50,000
----------------
71.50
Permit . . .
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
6/02/13
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
6/02/13
-
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
6/02/13
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 . . . . 12=00001406
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
427.50
.00
.00
427.50
Plan Check Total
236.28
.00
.00
236.28
Other Fee Total
2.00
.00
.00
2.00
Grand Total
665.78
.00.
.00
665.78
LQPERM IT
Bin #
Permit f
K"�
Y
Project Address;
A. P. Number:
Legal Desc> ptiow t)
Contactor:
Address: G
City, ST Zip: .
Telephone:- Z
State Lie. # : �
Arch., Engr., Designer.-
Address:
esigner:Address:
City, ST, Zip:
Telephone:
$%fe Lic. #:
Name of Contact Person:
Telephone # of Contactperson:
# Submittal Req'd
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan.
Gradingplan
Subcontactor-List '
Grant'Deed
H.O.A. Approval
IN HOUSE:
Planning Approval '
Pub. Wks. Appr
School Fees
City of La Q uinta . .
Building U Safety -Division
P.O. Box 1504, 78-495 Calle Tampico
U Quirita, CA 92253 - (7¢0) 777-7012'
Building Permit Application and Tracking Sheet
Owner's Name:
Address:j5Z _ U O
Ch City, ST, Zip: 4.v
✓ Telephone:
S `Project Description:.
Lic.
2
Construction Type: Occupancy:
t type (circle one): New Add'n 'Alter Repair Demo
7Sq.
lr
:
# Stories:.
# Units:
F tp Z Estimated Value.of Project:6,0(I
APPLICANT: DO NOT WRITE BELOW THIS LINE .
Rec'd
TRACKING ,
Plan Check submitted
PERMTr FEES
Item
Amount
Reviewed, ready for corrections
Called Contact Person
Plan Check Deposit.
Plan Check Balance
Plans picked up
Construction '
Plans resubmitted
Mechanical
2°" Review, ready for correctio» srssue
Electrical
Called Contact Person
Plumbing
S.M.I.
Plans. picked up
Plans resubmitted
Grading.
7rd Review, ready for correctionshssue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees
i
Wei
0
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