05-5417 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00005417
Property Address:
53561 VIA DONA
APN:
772-420-999-39 -298944-
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
20000
Tavl 4
f�'itiGv
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
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.
Licen a Cla C 3 License No.: 614611
.NaI4 Contrac r. CS
111 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.).
(_) 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
Prvpem; who Yuilda al, intpra o Ulld .ohv—liie-w ful die piujeua wiui a U1.11MaCLU11S) IlCelige(l
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: _
Lender's Address:
LQPERMIT
Owner:
JACOBSEN
53-561 VIA DONA
LA QUINTA, CA 92:
Contractor:
MCINTYRE POOLS &
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: 12/12/05
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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.
_XI 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 STATE FUND ' Policy Number 1769111
I 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 subject to the workers' compensation laws of California,
and agree that, if I shout become subject to the workers' compensation provisions of Section
3700 of the Labor C e I s all forthwit comply ith ts/e provisions.
M-tel�ku Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL 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.
'I. tach 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 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 comply with all
city and count ordinances and state laws relating to buildin nstruction, and hereby authorize representatives
of this o nt to enter upon the above-mentioned prop for action purp es. ^
Date: Signature (Applicant or Agent): /`
Application Number . . . . . 05-00005417
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . .207.00 Plan Check Fee 134.55
Issue Date . . . . Valuation . . . . 20000
Expiration Date 6/10/06
Qty Unit Charge Per Extension
BASE FEE 45.00
18.00 9.0000 THOU BLDG 2,001-25,000 162.00
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Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date 6/10/06
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE >100K 11.00'
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Permit . . . ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation . . . . 0
Expiration Date 6/10/06
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
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Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 33.00 Plan Check Fee 8.25
Issue Date . . . . Valuation . . . . 0
Expiration Date 6/10/06
Qty Unit Charge Per Extension
BASE FEE 15.00
2.00 6.0000 RA PTR FTXTTTT?R 13.00
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
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Special Notes and Comments
POOL & SPA. ALARMS/BARRIERS SHALL BE IN
LQPERMUT
Application Number . . . . . 05-00005417
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Special Notes and Comments
PLACE PRIOR TO PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED IN
PERMIT.
Fee summary Charged Paid Credited Due
-----------------------------------------------'----------
Permit Fee Total 311.00 .00 .00 311.00
Plan Check Total 160.55 .00 .00 160.55
Grand Total 471.55 .00 .00 471.55
LQPERMIT
City of Laui
Q nta
Building it Safety DMtsion
Permit00� P-0. Box 1504, 78.495 Calle Tampico
s� La Quinta, CA 92253 - (760) 777.7012
Building Permit Application and Tracking Sheet
X Project Address:
11
A. P. Number Owner's Name: /)
c�t?r
Address: ;\
Legal De
scttption: V DO I \
XCih. ST. Zip:(',
Contractor. C7
'
`_
(Telephone:
x Address: n;
T'1 Project Description:
X City, ST, Zip: 7N (7 n 12,
Telephone: ] '-C2 "`"`:-li
State Lic. N
City Lic. N:
Arch., Engr.. Designer:
Address:
City. ST. Zip:
Telephone: Construction Type-
State Lic. N: �h�-,�,r•'.:1 fir. '="�'•. • Occupancy:
Project type (circle one): New '
1C Name of Contact Person: - Addn Alter Repair Demo
X Telephone N of Co J
sq. Ft.; N Stories:
Contact Person: �' N Units:
stimated Value of Proiect:
Ar•LI%.ANT: DO NOT WRITE BELOW THIS LINE
N Submittal Req'd:!IY
TRACKING
Plan Sets PERMIT FEES
Plan Check submitted
Structural Coles, Item
Reviewed. readfor corrections Amount
Truss Clles Plan Check Deposit
Called Contact Person
Energy Glen.
Plans �leked up Plan Checl Balance
Flood plain plan Construction
Plans resubmitted
Grading plan hleehanica:
2" Review, ready for eorrections/issut
ntaetor List
SubeoElectrical
Called Contact Person
Grant Deed Plumbing
Psoas picked up
H.O.A. Approval SAM.
Plans resubmitted
IN HOUSE:.Grading
.._7 view, ready for eorreetions/issue
Plan 119 Approval Developer [mpact Fee
Pub. VI'Iu, Appr Called Contact Person
Date of permit issue A•I•P P
FT School Fees
Total Permit Fees
w..w t.
:
V
. �.