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11-0500 (RPL)P.O. BOX 1504 ` 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: z•---11-.000005_00` Property Address: + 5.3347 VIA MALLORCA APN: 777-390-005- - - Application description: POOL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 28000 - BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: BILL SHIELDS 53347 VIA MALLORCA LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760),777-7153 Date: 5/16/1-1 Contractor: ' . U Applicant: • Architect or Engineer- MCINTYRE POOLS & SPA NC. 83695•AVENUE 45 1 . INDIO, CA 92201 1.6 -20191 p�1J It (760) 342-3612OF ' Lic. No. 614611 CFS ��Nrq , - s - e 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 Class: C53 - • License No.:_ 614611. _=,c. - _ - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is rissued. - - ate: S ontractor.-i��C s - - i�F 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 DECLARATION insurance carrier and policy number are: - P I hereby affirm under penalty of perjury that 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 I should 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 - 3700 of the Labor 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 - �P%/! /%/[ l/•' any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate`; ) plican1. _ _ - 1 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.buildingnr improvement is sold within - SECTION 3706 OF THE LABOR cobs, INTEREST, AND ATTORNEY'S FEES. one year of completion, the owner -builder will have the burden of proving that he or she didnot 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, y- (_ 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 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 1 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 building constructigr(, and hereby authorize representatives • of this coup to enter upon thea ove-mentioned pro ertyf/f spec '� poses. Lender's Name: - - // - i�! 16 . , 1 Si ure (Applicant or Agent): ` Lender's Address: LQPERMIT " Application Number . . . . . 11-00000500 Permit . . . BLDG -POOL -PERMIT Additional desc . Permit Fee 271.50 Plan Check Fee 176.48 Issue Date Valuation 28000 Expiration Date 11/12/11 Qty Unit Charge Per Extension BASE FEE 252.00 3.00 6.5000 THOU BLDG 25,001-50,000 19.50 Permit . . ELEC POOL PERMIT=RES Additional desc . Permit Fee 45.00 Plan Check Fee.. 11.25 ,Issue Date" .. Valuation. 0 Expiration Date 11/12/11 Qty Unit Charge Per Extension BASE FEE . 15.00, 1.00 30.10000•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 .. 11/12/11- 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 174 OUTLETS 3.00 ----------------------- ----------------------------Special Notes and Comments RE -MODEL PARTIALLY COMPLETED POOL (SEE ORIGINAL PERMIT #07-87), USING EXISTING "EQUIPMENT, EXTENSIVE RE -PLUMBING,. RE -WORKING GUNITE. INSTALL GAS LINE TO BBQ & ADD 2 FIRE BOWLS. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION.EQUIPMENT ENCLOSURE EXISTING ---------------------------------------- Other Fees . . BLDG STDS.ADMIN (SB1473) 2.00 Fee summary Charged Paid Credited Due LQPERMIT - Application Number `. . . . . 11-00000500 Permit Fee Total 349.50 .00 .00 349:50 Plan Check Total 195.98 .00 .00 195.98 Other Fee Total 2.00 .00 .00 2.00 Grand Total 547.48 .00 .00 54.7.48 Bin # City of La Quinta Building U Safety Division P.O. Box1504, 78-495 Calle Tampico La•Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # !^ 'J 1 � Project Address: ' 3 UJ L( m7 Owner's Name: �. ' S t7e -s A. P. Number: Address: S ' 3 CO., Legal Description: Contractor:�� U 5 5 ZS �C: City, ST, Zip: Telephone: �iha" Address: L/ 1E. L1 (3 Project Description: City, ST, Zip: CIA - Telephone: Telephone: �� 6 f Sve State Lie. # : 6111 City Lic: #: Arch., Engr., Designer: - S a1 - 5 // o v/, Address: ,• - . J City, ST, Zip: Telephone: State Lic. #: S ". ; Name of Contact Person:I 14e— C' TY) Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: a G " U Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd , Reed TRACEING . 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 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"a Review, ready for corrections/issue Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed ) Plans picked up' S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees { f 1 c� S C { f 1 c� S 1 c� S Cf) { t rnt/ DD Y gill j,"gilig 1 1. 3gg 3