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11-0399 (RPL)T4hf. 4.4 Q"' P.O. BOX 1504VOICE (.760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT — _ Date: 4/18%11 _. Application Number: 11-00000399 Owner: Property Address: 80713 VIA GLOR3ETA NICOLSON PAULINP, APN: 772-270-010-44-3'1'1231- 3.450 ANNE MACDONALD WAY NORTH Application description: POOL -.RESIDENTIAL VANCOUVER; BC V7925-7 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 20000 Contractor. Applicant: Architect or Engineer: MCINTYRE POOLS & SPAS, i 83695 AVENUE 45 A°I� 2 Zoll r INDIO, CA 92201. (760)342-3612 PIP Lia. No.: 614611 WYOF OUINTA ------------------------------------------------ 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 affirm under 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 Clyss: C53 License No.: 614611 for by Section 3700 of . the Labor Code, for.the performance.of the, work for which this permit is ../ ,� issued. /Date:," ontractor: . 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 OWNER-BUILDER DECLARATION insurance carrier and policy'number are: - I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier GOLDEN EAGLE IN Policy Number 2010010139097Z 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 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 1 should become subject to the workers' compensation provisions bf Section ' License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or .3700 of the L bor Code, I'shall forthwith 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 ($500).: te: 1 pplicant: ' 1 _ 1 1, 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 1$100,0001. 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 (_ 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. mirsuent to the Contractors' State Linense Lew.). whose benefit work is nerformed tinder or oursuant to any permit i5wed o a result vt this aeglicativn, I—), I am exempt under Sec. BAP.C. 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. - 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 agre to comply with all 'work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, and h by aut n representatives of this unt to nter upon above-mentioned property for ins c ' r Lender's Name: _ - - ate: - nature (Applicant or Agent): Lender's Address: - LQPERMIT Application.Number11-00000399 Permit ... BLDG POOL PERMIT .Additional desc _. Permit Fee 207.00 Plan Check. Fee ,/ 134.:55 Issue Date Valuation 20000 Expiration Date 10/15/11 Qty Unit Charge Per Extension BASE: FEE 45.00 18.OQ. 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 10/15/11 Qty Unit Charge Per Extension BASE FEE. 15.00. 1.00 11.00.00 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.. 10/15/11 . Qty Unit Charge Per Extension BASE FEE 15.00 . 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 ... .10/15/11 Qty. Unit Charge .Per Extension BASE FEE 15:00... .. 2,,OQ 6.0000 EA' PLB FIXTURE' 12.00 1.00' 3 . bb00 EA PLB .WAXER 1NST/Suri'/KEV 3.'00 1.00 3.0000 EA . PLB GAS PIPE 1-4 OUTLETS 3...00' Special Notes and Comments POOL/SPA, GAS STUB -OUT FOR FUTURE BBQ. . LQPERMIT Bin # City of La Quihn - Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # n 3w1 . ` Project Address:. V �� Owner's Name: A. P. Number: Address: RO_ U.� n- In it,^ Legal Description: City, ST, Zip: Contractor:�10+4Pool S1 5 ZS In Telephone: p , T t> � Address: � 5• Project Description: City, ST, Zip:C—rt� S � Telephone: 1-361 m.x . )CM `, City Lic. #: I C �7 n to r f/:.. State Lie. # : 61 %t fl Arch., Engr., Designer: Address: . City, ST, Zip: Telephone: State Lic. #: _ Name of Contact Person:I k� ►^ Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: a j 0 `- \ 6 Estimated Value of Project: (� APPLICANT:. DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACMG . PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Energy Cales. Plans picked no Construction -Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review, ready for corrections/issue Electrical 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.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 0