05-4775 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:OS-00004
Property Address: 51735 VIA ROBLADA
APN: 772-270-010-29 -311231-
Application description: POOL - RESIDENTIAL•
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 20000
-TAt
Y/ 4.4Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer
LICENSED CONTRACTOR'S DECLARATION
I
Nov 0 '9 1005
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.
L
ic
ense Cla s: License No.:
.,_a a:
ate: Contract
r J
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 _ 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
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.).
1 _ 1 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
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. , BAP.C. for this reason
Date:
Owner:
CONSTRUCTIO14 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
ESCAMILLA
51-735 VIA ROBLADA
LA QUINTA, CA 92253
Contractor:
MCINTYRE POOLS & SPAS,
WCC: STATE FUND
WC: 1769111'
CSLB:614611
VOICE (760) 777-7012'
FAX (760) 777-7011
INSPECTIONS (760) 777-7153 ,v
Date: 10/25/05
INC:
01/01/06
09/30/07
'— ------------------------------------------
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. '
X. 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'C53 Policy Number - - - - - - - - - - - - - --
_ 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 Lab e, I shall forthwith comply with those rovisions.
/1 Applic�
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.
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 Quints, 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 county ordinances and state laws relating to building construction, and hereby authorize representatives
of thi5ed-u-ny to enter upon the above-mentioned prope or 'nspection purposes.
e: Vl Signature (Applicant or Agent): ✓ " \�
Application Number 05-00004775
Permit BLDG -POOL PERMIT
Additional desc .
Permit Fee .207.00 Plan•Check
Fee
134.55
Issue Date Valuation
20000
Expiration Date 4/23/06
' Qty Unit Charge Per
Extension
BASE FEE
45.00
18.00 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 4/23/06
Qty Unit Charge Per
•Extension
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 4/23/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
.1.00 30.0.000 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 4/23/06
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 ONLY. ALARMS/BARRIERS SHALL
LQPERMIT - - -
rl
Bin #
Permh #
0s-� %7S
Project Address:
A. P. Number:
Legal Description:
Contractor:
Address: Y
7)f . C "" /e
Cin, ST, Zip:
Telephone: X C. Z
State Lic. # : X, (D Ci
Arch.. Engr., Desiper:
Address:
City. ST, Zip:
Telephone:
State Lic. #:
Cit} Of la Quinta
Building at Safety L t ition
P.O. Box 1504, 78.495 Calle Tampico
La Quinta, G4 92253 - (760) 777.7012
Building Permit Application and Tracking Sheet
Owner's Name: X
Address: X _ f
City. ST, Zip: K .
Telephone:
Project Description: Y
Lic. #:
L
Wr-
a �
Construction Type: Occupancy:
Project typd (circle one): New Add'n Alter Repair Dcmc
Name of Contact Person: x Ia C
L. Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: X
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE:.
Planning Approval
Pub. Wks. Appr
School Fees
Estimated Value ofProject: X z.Lq.0 0 �mb t, 04J
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd TRACKING PERMIT FEES
Plan Check submitted
Reviewed, ready for cor
Called Contact Person
Plans picked up
Plans resubmitted
2"° Review, ready for coi
Called Contact Person
Plans picked up
Plans resubmitted
hd Review, ready for core
Called Contact Person
Date of permit issue
•ections
rections/issue
0 2
Item
Plan Check Deposit
Plan Check Balance
Construction
Mechanical
Electrical
Plumbing
S.M.I.
Amount
Grading
ections/is
ue
Developer Impact Fee
A.I.P.P.
Total Permit Fees