05-5353 (RPL)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX.(760) 777-70117
LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777--7153
BUILDING PERMIT
Date: '12/ 08/05
'
Application Number: , 05 00005353_-_ '# _ Owner:
_ _
Property Address: 78380 VIA PAVION GATLIN
APN: 604-032-999-54 -305212- 78-380 VIA PAVION
Application description: POOL - RESIDENTIAL LA QUINTA, CA
Property Zoning: LOW DENSITY RESIDENTIAL LA QUINTA, CA 92253
Application valuation: 15000
Contractor: D 0
Applicant: Architect or Engineer: ^ •MCINTYRE POOLS & SPAS, IN
83695 AVENUE 45
/ INDIO, CA 92201x p
N
(/ e (760)342-3612 DEC O oOO�
Lic. No.: 6.14611 CITYORjLpaNiNiA
RIN N
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirmunder penalty of perjury one of the following declarations:
Section 7000) of Division.3 of the Business and Professionals Code, and my License is in full force and effect. - I have and will'maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: .1753 License No.: 614611 for by Section 3700 of the Labor Code; for the performance of the work for which this permit is
,I �/• issued.
ate _ Contractor• - _ y �G �i �'G4�a. /b I have and will maintain workers' compensation insurance, as required by Section 3700 of the_Labor
T Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER D2 RATION insurance carrier and policy number are: "
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND - Policy Number 1769111.
following reason (Sec. 7031.5,- 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,notemploy 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' compens tion 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 should become subject to orkers' compensa ' n provi ' s of Section.
License Law (Chapter.9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or./DOLLARS
7 of the.Labor Code, I sh hwith mply with. those pr ions.
- 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).: Applicant! �>Ls
(_ 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* - FAILURE TO
SECURE WORKE COMPENSATION ERAGE S UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, PLOYER TO CRIMINA ENALTIES AND CIVI INES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own'employees, provided that the 0001. IN ADDITIO 0 THE COST OF CO PENSATION, DAMAGES AS PROVIDED FOR 11
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR DE, 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
(' 1 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 contractor(s) 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 I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinia, 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.
I 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 compl with all
work for which this permit is issued (Sec. 3097, Civ, C.). _ city and county ordinances and state laws relating to building construction, an ereby authorize repre atives
of th' ounty t enter upon the above-mentioned property fo Mion pLender's Name _ -
Date Signature (Applicant or
Lenders Address: - - -
LQPERMIT - _ '
Application Number . . . . ..�05-00005353
Permit. BLDG POOL PERMIT
Additional desc .
-. Permit--Fee--. 162.00 Plan Check Fee
105.30
Issue Date. Valuation
15000
_ 'Expiration Date -. 6/06/06
- Qty Unit Charge .Per,
Extension
j
BASE FEE
45.00
.13.00 9.0000 THOU BLDG 2,001-25,000
117.00
Permit . . MECH. POOL
Additional.desc .. .
Permit Fee. 26.00 Plan Check Fee
6.50
Issue Date Valuation . . . .
0
Expiration,Date .. 6/06/06
. 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 6/06/06•
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 6/06/06
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
3.0.0
Special Notes and Comments
" POOL & SPA ONLY. ALARMS/BARRIERS SHALL
Application Number . . . . . 05-00005353
- ---------------------------
Special'Notes and Comments
------------------------------
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED •.IN,'PERMIT.
Fee summary Charged
Paid
Credited _
Due
Permit Fee Total 266.00
00
.00
266.00
Plan Check Total 131.30:
.00
.00
131.30
Grand.Total 397.30
.00
.00
397.30
v
�
t
' LQPERMIT
Bin #
City of LaQ Uinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
B ilding Permit Application and Tracking Sheet
Permit #
�.
3.3
Project Address:' Q u USO
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: P •
Address:
Telephone: —
Project Description:
City, ST, Zip: `� v
U
Telephone:
State Lic. # : C
Arch., Engr., Designer:
City Lic.
C
Address:70—
OCity,
City,ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person-
Construction Type: Occupancy:
Project type (circle one)• New dd'n Alter Repair
Demo
Sq. Ft.G G
# Stories:
#Units:
Telephone # of Contact Person:
Q
eq
Estimated Value of Projec
APPLICANT: DO NOT WRITE BELOW THIS LINE L`51 am
q
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2°" Review, ready for correctionsrssueElectrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.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
Total Permit Fees