05-5416 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
J Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
05-00005416_ 7
J
80255 VIA'MIRASOL
772-430-006- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
t
' 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 Class• C53 License No.: 614611
at Contractor. (6)��
JJ
.OWNER -BUILDER DECLARATION
1 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).: -
_
I_) 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 ISec.
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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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.I.
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
JOHNSON
80-255 VIA MIRASOL
LA QUINTA, CA 92253
Contractor:
MCINTYRE POOLS & SPAS,
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
CrrY OF LA T. A
�IPId1NCE DEP L -
-----------------------------------------------
-WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: - -- - - - - --
1 -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 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 should become subject to the workers' compensation provisions of Section
3700 of the Labor C ddf I all forthwith comply with those provisions.
D e Applicant:
WARNI : I UR
FAE 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. -
1 . Each 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 c"aordinances and state laws relating to bui ' -' construction, and hereby authorize representatives
of th' o enter upon the above-mentioned pr r inspection [urpose,
.
D Signature (Applicant or Agent).
Application Number
05-00005416
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
18.0.0' 9.00.00
7-7 -------------------------------------------------------------------------
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
-6/10/06
Qty Unit. Charge.
Per
Extension.
BASE FEE
15..00
1. 00 -.11.0000
EA MECH FURNACE >100K.
11.0,0."
Permit •.. . . . . .
POOL PERMIT -RES
.ELEC
AddAiojaal disc -
Permit Fee
45.00 Plan Check Fee
.11.25
Issue Date
Valuation
0.
Expiration.Date
6/10/06
Q'ty:-Unit.Charge
Per
Extension..
BASE FEE
15.00
1.00 30.0000
EA ELEC PRIVATE SWIMMING POOL
3"0'00 .
. 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
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
3.00.
Special Notes and Comments
POOL & SPA. ALARMS/BARRIERS SHALL BE IN
LQPERMTT
Application Number 05-00005416
-- ------------------------------------------
Special Notes and Comments
PLACE PRIOR TO PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED IN
PERMIT.
Fee summary Charged- Paid Credited Due
City of La Quinta
Building a Safety Divtslon
Permit 11 P.O. Box 1 SO4r 78-49S Calle Tampico
QS ��� U Quinta, CA 922S3 - (760) 777.7012
Project Address:
Building Permit Appiication and Tracking Sheet
1f
�' � Owner's Name: (, ��
A. P. Number.
Address: S�-1(A 1 gSib
Legal Description: � \!!
XCity. •Ac. ST. Zip: <.A\
Contractor.
XAddress: � ^ v F Tele phone:
X Cil)-, ST, Zip:
nn Project Description:
�lV vl2-�
A Telephone:
State Lie. q
MMMMWM�City Lie. M:
Arch., Engr.. Designer.
Address:
City, ST. Zip:
State Lic. il: s r-;ti'f' •�`� ;
construction Type:
Occupancy:
1( Name of Contact Person: _ _ Project type (circle one): New
-------------
Add'n Alter Repair Demo
X Telephone sr of Contact Person: � Sq• Ft.; (' Stories'
Enits:
"= stimated Value of project:
ArrLi%-ANT: DO NOT WRITE BELOW THI
p Submittal S LINE
Req'd Reed
TRACKING
Plan Sets PER\IIT FEES
Plan Check submitted-
Structural
ubmittedStructural Coles. 1i•III, 05 Item
Reviewed, ready for corrections Amouat
Truss CaICs Plan Cheek Deposit
Called Contact Person
Energy Gales,
Plans Oleked up Plan Check Balance
Flood plain plan Construction
Plans resubmitted
Grading plan Mechanical
2" Review, ready for eorrecdonsAisue
Sutxoataetor List Electrical
Called Contact Person
Great Deed Plumbing
Plans picked up
H.O,A. Approve! SAM.
Plans resubmitted
IN HOUSE:. Grading
'"' Review, ready for torreetionsAssue
Planning Approval Developer Impact Fee
TP=ub.'%'kL Appr Called Contaet Person
Date of permit i�F ssue �'►•I•P P
School Fees
Total Permit Fees