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11-0317 (RPL)P.O. BOX 1504 y . VOICE (760) 777 7012 - 78-495 CALLE TAMPICO .FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 • BUILDING & SAFETY -DEPARTMENT INSPECTIONS.(760) 777-71`53 BUILDING PERMIT ; Date: 3./30/11 Application Number(I1'`60000317 Owner. ' Property. Address: 53180rVIA'•`VICENZE JACKMAN JAMES/BETH , APN: 7.77-180_=002- - - - 53180 VIA VICENZE Application description: POOL - RESIDENTIAL LA QUINTA, ' CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 35000 ti Applicant: Architect or Engineer: MCINTYRE POOLS & SPAS,, IN 4 83695 AVENUE 45 A INDIO CA 92201' RR 11 ..2011 ita (760)342_3612 1 ,. �/� A LiC. No.: 614611 r ,. CIIYOF L,q IpNTA - - FINANCE -•— _ ! — — —tip ----------------- — —-+~UOENSED CONTRACTOR'S DECLARATION - — - — s.. — — — - — - — — - — -WORKER'S COMPENSATION DECLARATION ----------------------- — _ — — —•_ — — — — — " I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with • ^ _ , . Y I hereby affirm under penaltyof.perjury one of the following declarations: Section 7000) of Division.3 of the Business and Profe sionals Code, bpd 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 Cla i C53�ntract;�r.�� 614611 .for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ^ �/issued:/ate:. �� " - ` , , ' - F I have and will maintain workers' compensation insurance, as required by Section.3700 of the Labor,.. ' _ ' 'r 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 .' e - _ I certifythat, 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.ihe person in anymanner 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 su 'ect_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 �� 00 of the Labor Code, I hall fo it I h those,proAsions. ., ;?. • , that he *or she is exempt therefrom and the basis for'the alleged exemption. Any violation. of Section 7031:5 by _ any applicant for apermit subjects the applicant to acivil penalty of not more than five hundred dollars ($5001: �,., e: plicanti... 0 (_ ): I, as owner of the property, or my employees with wages as their sole compensation, will do the work,. and - - - - • r•.. ' r thestructure not -intended or offered for sale (Sec. 7044,Business and Professions Code: The WARNING: AILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law doe's not apply to an owner of property who builds or improves thereon b` 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 (5100,000).- IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDE6.FOR IN improvements are not intended or offered for sale. if, however, the building or improvement is sold within " .w i 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 - (_) 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 Contractorst'State License. Law.).. whose benefit work is performed under or pursuant to any permit issued as a result of this application, (._ ) I am exempt under Sec. , B.&P.C, for this reason - = the'owner, and the applicant, each agrees. to, and shall defend, indemnity and hold harmless the City",. ' of La Quinta, its officers, agents and employees for any actor omission related to the work being r 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 issuanceofsuch 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 formation is correct. I agree to comply with all work`for`which this permit is issued (Sec. 3097, Civ. C.). a - , - 'f city and county ordinances and state.laws relating to building construct n,.and 1 y authorize representatives , of this �uennteriuthe above-mentioned propert fo i e - s.-Lender'sName: - ate:ure (Applicant or Agent): '.Lender's Address: • LQPERMIT ` Application Number _ -11-00000317 Permit. BLDG'.POOL PERMIT Additional desd 'Permit Fee :377.00,. Plan'Check Fee.. 206.05 Issue. Date' Valuation 35000 Expiration'Date 9/26/11 Qty ..Unit Charge Per Extension BASE FEE 252.00 10.00 6:5000 THOU BLDG 25,001-50,000• 65.00. Permit MECH'POOL. Additional• desc . Permit Fee 26.00 :Plan Check Fee.': 6.50 Issue Date Valuation 0 Expiration Date.. 9/26/11 Qty Unit Per = Extension` . ,Charge- -BASE FEE 15:00 1.00 11.0000 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 9/26/11 Qty Unit Charge .Per. Extension ..., BASE FEE 151.00 1.00 :;':'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 .. 9/26/.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 1-4'OUTLETS 3.00 Special:Notes and Comments POOL/SPA,' WATER.FEATURE & FIREPIT. . LQPERMIT. ' Application Number 11-00000317 - - ------------------ Special Notes and. Comments -------------- -------------- ALARMS/BARRIERS SHALL BE"IN.PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE<NOT INCLUDED. 2010 CODES. ------------------ ' Fees . . . ... . . . BLDG STDS ADMIN (SB1473). OtherFee summary Charged 'Paid Credited Due Permit Fee Total 421.00 .00 .00 421_00 Plan Check Total 232.05 00 .00 232.05 Other Fee Total 2.-00.. ..00 .00 2.0.0" Grand Total. :655.05 .00: :00 655.05 ". . LQPERMIT Bin #: ' ,. City of La "Quints Building 8E Safety Division P.O. Box 1504, 78-495 Calle Tampico 'La Quinta, CA 92253 - (760) 777-7012 Building. Permit Applicalo' n and Tracking Sheet Permit # Project Address: �j`� ' �� Uict Owner's Name: z(tC C ao A. P. Number: �o Address: 3> — �U UlU V (CBI -)a 'Legal Description: City, ST, Zip: lj: , e - Contractor:C 64 il-e PC Q1 T elephone:' Y 5 Address: - ()le • _5• Project Description: City, ST, Zip:C,A— S.I" `kir RL& Telephone: i i MEN: , • �:.: 0. City Lic. #: � _ Ui t P'� State Lic. # : 61 � 6l Arch., Engr., Designer: Address: ' City, ST, Zip: Telephone: t a p State Lic. #: f/ Name of Contact Person: i i1i e ►^ Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories: # Units: Telephone # of Contact Person: S G `- �., � Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACIUNG 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°" 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.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees