05-5411 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: X05-00005411
Property Address: 78380 VI.A PAVION
APN: 604-032-999-54 -305212
Application description: STRUCTURES OTHER THAN BU
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000 1,1
Applicant:
LICENSED CONTRACTOR'S DECLARATION
Titvl 4 4"Q"
BUILDING & SAFETY DEPARTMENT
_ . BUILDING PERMIT
cO®
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
.Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: CS LicenseNo.: 614611
!Date:/ �' Cont or. y !�
,,,.,-Date::
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 (5500).:
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 improvementissold 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.).
(_ 111 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 town 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—) I 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:
/ tender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/12/05
Owner:
GATLIN
78-_380 VIA PAVION.
LA QUINTA, CA
LA QUINTA, .CA 92253
Contractor:
MCINTYRE POOLS & SPAS,. INC.
83695 AVENUE 45
INDIO, CA 92201
(760)342-3612
Lic. No.: 614611
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 andpolicy number are:
Carrier STATE FUND Policy Number 1769111
certify that, in the performance of the work for which this permit is issued, I'shall not employ any
person in.any manner so as to become su ject to the workers' compensation laws of California,
and agree that, if I should becomsuWe-t to the worker 'compensation provisions of Section
370 of the Labor Code, I fo with comply wit ose n isions.
DatE:� - .Uplican �f GL —
WA ING FAILURE TO SECURE KERS''COMPENSr ION COVERAGE IS UNLAWFUL,.AND SHALL
SlV] JE AN EMPLOYER TO CR NAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOL S($100,000). IN ADD ION 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 t
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.Ouinta, 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 of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to com with all
city and county ordinances and state laws relating to building construction, and h by authorize rep sentatives
of t%h�county ip4nte upon the above-mentioned property for inspe +3n pur as.
Date:/'2 i ,' signature (Applicant or Agent): - v -
Application Number .
. . . 05-00005411
Permit . .`
BUILDING PERMIT
Additional desc
Permit Fee.
72.00
Plan Check Fee
46.80
Issue Date
Valuation
5000
Expiration Date
6/10/06
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
3.00 9.0000
THOU BLDG
2,001-25,000
27.00
Permit
ELEC-MISCELLANEOUS
Additional desc .
Permit.Fee . . . .
17.25
Plan Check Fee
4.31
Issue Date
Valuation
0
Expiration Date
6/10/06
Qty Unit Charge
Per
Extension .
BASE
FEE
15.00.
3.00• 7500
PER ELEC
DEVICE/FIXTURE •1ST 20
2.25
Permit . . .
PLUMBING .
Additional desc .
Permit Fee
18.00''
Plan Check Fee
4.50'
•Issue Date . .
Valuation . .
. 0
Expiration Date
6/10/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 `3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00. .
- --- -- -- -- -- --------------.---------,-----
Special Notes and (Comments
-
-BARBEQUE ONLY #.Z21-58-1995.
Other Fees . . . .
ENERGY REVIEW FEE
4.68
Fee summary Charged
Paid Credited.
Due
Permit Fee Total
.107.25
.00 .00
107.25
Plan Check Total
55.61
.00 .00
55.61 '
Other Fee Total
4,.68
.00 .00
4.68
Grand Total
167.54
:00 .00
167.54
LQPERMIT
Bin #
City. of La Quinta
Building u 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 #
OS J S 1
Project Address:' Q u UID
Owner's Name:
A. P. Number:
Address: v pa
City, ST, Zip:
Telephone: G
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el'_
Legal Description:
Contractor: --
vc' 9
Address:
S
Project Descri tion:
u
p
G
City, ST, Zip:
Telephone:
State Lic. # : G City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circleone)• New dd'n Alter Repair
Demo
Name of Contact Person:
Sq. Ft.:L G 3
# Stories:
# Units:
Telephone # of Contact Person:
D
Estimated Value of Projec -�
APPLICANT: DO NOT WRITE BELOW THIS LINE P,
q
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
Construction S
50Te
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
Subcontactor List
2" Review, ready for co rrectionsrssue
Called Contact Person
Electrical .41
Plumbing
3 - Fxrutes
-"1/. oorlgCs
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