13-0054 (RPL)V P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: \ 13-00000054
Property Address: 52535 HUMBOLDT BLVD
APN: 767-200-091-19 -34968
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 38600
Applicant:
I hereby affirm under penalty of perjury that I am
Section 7000) of Division 3 of the Business and I
License Class: C53
Da /7• ! 3 Contract
T449 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
EAST OF MADISON LLC
PO BOX 1482'
LA QUINTA, CA 92247
Contractor:
Architect or Engineer: MCINTYRE POOLS & SPAS,
83695 AVENUE 45
INDIO, CA 92201
(760)342-3612
Lic. No.: 614611
I'S 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 f perjury that I a exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5 Business and Pr fessions Code: Any city or county that requires a permit to
construct, alter, improve, demo' h, or repair a structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement at he or sh is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commenc with S tion 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom an asis 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 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
Dat
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: rN
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
'INSPECTIONS (760) 777-7153
Date: 1/17/13 -
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 performa ce of the work for which this permit is
/ issued.
Y I have and will maintain workers' compensation insuranc s requir b Section 3700 of the Labor
Code, for the performance of the work for which this rmit is
su My workers' compensation
insurance carrier and policy number are:
Carrier BENCHMARK INS Policy Number W00 2
I certify that, in the performance of the work for whic his pe it i issued, I shall not employ any
person in any manner so as to become subject to a wor rs' mpensation laws of California,
and agree that, if I should become subject to the orkers' co pensation provisions of Section
37`70,0 of the Labor Code, I shall forthwith comp, with t s rovisions.
Dat — f %— / ✓ Applicarl
WARNING: FAILURE TO SECURE WORKERS' f 1PENSAT ON COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES AND IVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO HE COST OF DMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AN ATTORNEY'S FEES.
VPBMCANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the DirectorofBuilding 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 hol mless the City
of La Quinta, its officers, agents and employees for any act or o ission related th ork being
performed under or following issuance of this permit.
2. Any -permit issued as a result of this application becomes null a /d, n commenced
within 180 days from date of issuance of such permit, or ce 80 days will subject
permit to cancellation.
I certify that I have read this application and state that the above inform ioree to comply with all
city and county ordinances and state laws relating to building construc on, rize representatives
of this county to enter upon the above-mentioned pro/perty for inspec n pu
13t5e: �ignature (Applicant or AgelXf:
LQPERMIT
• Application Number .
. . . . 13-00000054
Permit _
MECH POOL
Additional desc .
Permit Fee,
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
'"Expiration Date
7/16/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
----------------------------------------------------------------------------
EA MECH FURNACE >100K
11.00
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
343.00 Plan Check Fee
222.95
Issue Date
Valuation . . .
. 38600
Expiration Date
7/16/13
Qty Unit Charge
Per-
Extension
BASE FEE
252.00
14.00 6.5000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
91.00
Permit
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
7/16/13
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
7/16/13
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, & 18" FIRE
PIT WITH 75' OF 1'
LQPERMIT
LQPERMIT
Application Number . . . . .
13-00000054
-------------------------------------------------------
Special Notes and Comments
GAS LINE.ALARM/BARRIERS SHALL
BE IN
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 447.00
----------
.00
--------------------
.00
447.00
Plan Check Total 248.95
.00
.00
248.95
Other Fee Total 2.00
.00
.00
2.00
Grand Total 697.95
.00
.00
697.95
LQPERMIT
Bin #
City of La Quinta. .
��
Building 8L SafetyDivision
Permit #
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (7¢0) 777-7012
now IN
Building Permit Application and Tracking Sheet
Project Address; _ A,✓
Owner's Name:
'0 n
Telephone:- -3
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
��
Telephone:
Project Description:.
Address: _
City, ST, Zip: 1
Telephone:- -3
i
State Lie. # :
City Lid. #:.
Arch., Engr., Designer:
Address:
City, ST, Zip:
r.
Telephone:
Construction Type:
Occu an
p cy:
State Lib. #:
Project type (circle one):
New Add'n 'Alter Repair Demo
Name of Contact Person:t
77,Sq. FL: #Stories: #Units:
'
Telephone # of Contact -Person: '
C,0—�p Estimated Value.o�Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
.
# Submittal Req'd •
Rec'd TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for correctionsPlan
Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
Construction
Flood plain plan,
Plans resubmitted
Mechanical
Grading.plan'i
244 Review, ready for corrections/issue
Electrical
Subcontactor List
Called"Contact Person
Plumbing
GranfDeed
Plani. picked up
S.M I.
Ii O.A. Approval
Plans resubmitted
Grading.
IN HOUSE:
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval '
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees