08-1038 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08-00001038
Property Address: 52125 DAY STAR DR.
APN: 767-200-999-19 -312023-
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 23000
Applicant -
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am I ensed er provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and rofessi s Code, and my License is in full force and effect.
License Class: C53 License No.: 614611
Date: F 'Dlli Contractor:
Ov OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that 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).:
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, 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 _ 1 I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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:
FIELDS RESIDENCE
52-125 DAY STAR DR
LA QUINTA, CA 92253
Contractor:
MCINTYRE POOLS & SP
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: 6/19/08
tCJUN
A 10 19 2009
CITY OF LA QUINTA
FINANCE DEPT.
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 DELOS INS CO Policy Number 01DKRM12001870
I certify that, in the performance of the work r which this permit is issued, 1 shall not employ any
person in any manner s1111
ecome ct to the workers' compensation laws of California,
and agree that, if I shoe su to the workers' compensation provisions of Section .
3700 of the Labor Codfo comply with those provisions.
Date: (> -/9,12( Applicant:
WARNING: FAILURE TO SECUE W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI NAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, 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 null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation f work for 180 days will subject
permit to cancellation.
1 certify that I have read this application and state that the above in rmatio i correct. I agree to comply with all
city and county ordinances and state laws relating to building con ructi d hereby authorize representatives
of this county to enter upon the above-mentioned property for i pect' rposes.
Date: (-/�1//1 Signature (Applicant or Agent):
Application Number . . . . . 08-00001038
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee
234.00 Plan Check
Fee
152.10
Issue Date . . . .
Valuation
. . .
. 23000
Expiration Date .
12/14/08
Qty Unit Charge
Per
Extension
'BASE FEE
45.00
21.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
189.00
Permit . . .
ELEC POOL PERMIT -RES
Additional desc . .
Permit Fee . . . .
45.00 Plan Check
Fee
11.25
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date . .
12/14/08
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 . . .
27.00 Plan Check
Fee
6.75
Issue Date . . . .
Valuation
0
Expiration Date
12/14/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 6.0000
EA PLB FIXTURE
6.00
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, ALARMS/BARRIERS
SHALL BE IN PLACE
AT PRE -PLASTER INSPECTION.
EQUIPMENT
ENCLOSURE NOT INCLUDED.
Fee summary Charged
---------------------------
Paid Credited
------------------------------
Due
Permit Fee Total
306.00 .00
.00
306.00
Plan Check Total
170.10 .00
.00
170.10
Grand Total
476.10 .00
.00
476.10
LQPERAIIT
Bi" #
City of La Quinn-
'Building U SafetyDivision
P.O. Box 1504, 78-495 Calle Tampico
UQuirita, CA 92253 - (740) 777-7012
Building Permit Application and Tracking Sheet
Permit #
d
1.
Project Address:' 5 L- 2 5- VQ 5.�QA rf
Owner's Name: S
A. P. Number:
Address: 52—/ 25' QSA'b.P_.D
Legal Description:
City, ST, Zip: L Z
Contractor: O
Address: 03 _ s
Telephone:
Project Description:.Qal
City, ST, Zip:. 6 en. 9e7,C1
Telephone: 3-4Z- 36
State Lic. # : C 53 .
City Lit. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft :
#Stories:
#Units:
Telephone # of Contact-Person:2,50— '96 Z
Estimated Value.of Project: 2 3 � (?�
APPLICANT:. DO NOT WRITE BELOW THIS UNE .,
#
Submittal
Req'd
Recd
TRACMG f
PERMIT FEES
Plan Sets
Plan Check submitted
-Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
'Construction
Flood plain plan,
Plans resubmitted
Mechanical
Grading.plati .
2'd Review, ready for correctiotisrssue
Electrical
Subcontactor.List '
Called'ContactPerson
Plumbing
Grant'Deed
Plaas_picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading.
IN ROUSE:
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
Total Permit Fees
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