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05-2396 (RPL)P.O. BOX 1504 �^o VOICE 760 777-7012 78-495 CALLE TAMPICO " FAX,(760) 777-701.1 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 6/17/05 Application Number. OS^00002396 Owner- Property Address: 80VI=AMPES.SARO D e JACOBSEN JANICE B :APN: 772-500-069- - - 80-769 VIA PESSARO- Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning:' LOW DENSITY RESIDENTIAL JUN 2 2 2008 Application valuation: 20000 J C1�Y OF l� QUINTA . FINdAICf� 13��1: Contractor: Applicant: Architect,or Engineer: MCINTYRE POOLS & SPAS, INC.- WCC: STATE FUND WC: 1769111 01/01/06 C_ ofe �D /A CSLB: 6.14611 09/30/05 ©rvrkACGI • - LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION _ hereby affirm under penalty of erjury that I am licensed under provisions of apter 9 Ic mmencingwith I hereby affirm under penalty of perjury one of the following declarations: ,//Section 70001 of/v�r�v,�sio sof t e Business and Professionals Code, and m c ns is'�'n/Full/rc$ an effect. I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided , License Class: ` r License No.: � Z• 4 C for by Section 3700 of the Labor Code, for the performance of the work for which this permit is �issued. • te4Z�A22 Contractor� 9 ^ tziE Imo v ` S - %� 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 . 'y penalty p. OWNER-BUILDER DECLARATION insurance carrier and policy number-are: •' I herebaffirm, under enalt of erjury that I am exempt from the Contractor's State License Law far the rrier C53 _ Policy Number ------- following - ---following reason (Sec. 703.1.5, Business and Professions Code: Any city or county that requires -a permit to I certify that,: in the performance of the work for which this permit is issued, I shall not employ any ,. construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State - and agree that, if I sh Id become subject to the workers' compensation provisions of Section , License Law (Chapter 9 (commencing with Section 7000) of Division 3' of the Business and Professions Code) or 00 of the Labor o all fo hwith comply with those provisions. - 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 (S500L: 1 Applicant: - - (_ 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL - Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the - - .. DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND, ATTORNEY'S FEES. 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.). - - APPLICANT ACKNOWLEDGEMENT (_ I I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the . - 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the.projects with a contractorls) licensed _. 1. Each person upon whose behalf this application is made, each person at whose request and for " pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1 _ 1 I am exempt under Sec. , B.&P.0 for this reason 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. Date: - Owner: - 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 of work for 180 days will subject " CONSTRUCTION LENDING AGENCY permit to cancellation. ' hereby affirm under penalty'of perjury that there is a construction lending agency for the performance of the - I certify that I have read this application and state that the above information is correct. i agree to comply with all - work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to buildin - nstruction, and hereby authorize representatives - of thi;uy toenter upon the above-mentioned grope for action purpose . Lender's Name: C Signature (Applicant or Agent): Lender's Address: - Application Number . . . . . 05-00002396 Permit . . BLDG POOL.PERMIT Additional desc . Permit Fee 207.00 Plan Check Fee 134.55 Issue Date . . . . Valuation . . . . 20000 Expiration Date 12/14/05 Qty Unit Charge Per 'Extension BASE FEE 45.00 18.00 9.0000 THOU BLDG 2,001-25,000 162.00 Permit . . MECH POOL Additional desc _.. . Permit Fee 26.00 Plan Check Fee.. 6.50 Issue Date . ... - ,Valuation 0 Expiration Date .. 12/14/05 Qty Unit Charge Per `-Extension BASE ;FEE 15..00 ., 1.00 111.0000 EA ..MECH FURNACE. >100K 11100 PermitELEC POOL PERMIT -RES Additional desc.• .' Permit Fee 45.00• Plan.Check'Fee 11.25 ` Issue Date . :.:. Valuation.. 0 ` Expiration Date 12/14/05 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 12/14/05 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 ONLY.'ALARMS/BARRIERS SHALL LQPERMIT - . Bin Permit # Project Address: A. P. Number: Legal Description: X Contractor: M,C-TN '; ' j� Address: _ S A0 7� City, ST. Zip::�7N C,tb 0 a X Telephone:. �2 3 (� (a State Lic. 0 : 14 Arch., Engr., Designer: Address: Ciy. ST. Zip: Telephone: State Lic. 1C Name of Contact Person: X Telephone tt of Contact Person: �7, N Submittal Plan Sets Structural Cala. Truss Calcs. Energy Cala. Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees City of La Quinta Building ac Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet S City Lic. 0: 4 Owner's Name: >(Addms: gr 'City. ST. Zip: FTelenhone- Description: )Y V(A T)a��At'n UNNLC� ._. - • - = =Construction Type: Occup a'�, —fir :.•'r.' _ Vis: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: ' N Stories: N Units: S f Estimated Value of Proiect• APPLICANT: DO NOT WRITE BELOW THIS LINE Recd TRACKMG Plan Check submitted tD Reviewed, ready for corrections Called Contact Person Plans picked up Plans resubmitted 2-' Review, ready for correctionstissue Called Contact Person Plans picked up Plans resubmitted 3d Review, ready for corrections/issue Called Contact Person Date of permit issue PERMIT FEES Item Plan Check Deposit Plan Check Balance ------------ Construction Mechanical Electrical Plumbing SAI.1. Grading ------------ Developer Impact Fee A.I.P.P. Total Permit Fees Amount ' 1