05-4782 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05 00004782
Property Address: 51735 VIK ROBLADA
APN: 772-270-01Q-29 -311231-
Application description: STRUCTURES OTHER , THAN BU
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: -5500
Applicant-
.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
..:llUlr
Architect or Engineer:
NOV 0 2 2005
T� Contractor:
MCINTYRE• POOLS .& SPAS, INC.
WCC: STATE FUND .
WC: 1769111 01/01/06 .
CSLB: 614611 09/30/07
OF LA Q1919V
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.
.. License 1C18
s � L'icense No.:
Safe: l .� Contractor: ('!/V 1
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).:
(_) 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.). -
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.).
f 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.).
Lender's Name: Y
Lender's Address: -
�\ LQPERMIT-
Owner:
ESCAMILLA
51-735 VIA ROBLADA
.LA QUINTA, CA 92253
VOICE. (760) 777-7012,E
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/25/05
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 performanceof 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 C53 Policy Number - - - - - - - - -•- - - - - -. -
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 I shall forthwith comply with those provisions. -
D [ Z Ap scant:�[� C IQG
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 FOFi 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 aresult 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-) 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 buil g construction, and hereby authorize representatives
of t s o my o enter upon the above-mentioned pr ert or inspection purpos� ..
Date: Signature (Applicant or AgentL`
0
Application Number 05-000.04782
0,
Permit . . BUILDING PERMIT
Additional desc
Permit'Fee 81.00
Plan Check Fee
-. 52..65` .
Issue.Date
Valuation
.5500
Expiration Date .. 4/23/06
Qty Unit Charge .Per
Extension
BASE
FEE
45.00
4.00 9.0000 THOU BLDG
2,001-25,000
36.00
Permit ELEC-MISCELLANEOUS
Additional desc'.
Permit Fee_ 16.35
Plan Check Fee
4.09
Issue Date
Valuation
0
Expiration Date 4/23/•06:
Qty Unit Charge .Per
Extension
BASE
FEE
15.00.
3.00- .4500 EA- ELEC
---------------------------------------------------------------------------
DEVICE/FIXTURE >20
1.35•
Permit .PLUMBING
Additional desc .
Permit Fee 18.00.
Plan `Check Fee
4.50
Issue Date
Valuation
�0
Expiration Date .4/23/06
Qty Unit `Charge Per
Extension
BASE
FEE
15.00
1.00 3:0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
---------------------
Special Notes and Comments
-------------------------------------
FIREPIT & BARBEQUE ONLY..
-----------------------------------------
Other Fees: f ENERGY REVIEW FEE
5.27 ----
Fee summary'. Charged
Paid Credited
Due
Permit Fee Total 115.35
------------.---
.00 .00
--- - - - - -
'115.35
Plan Check Total 61.24'
.00 .00
61.24
'Other Fee Total 5.27
.00 .00-
5 27
Grand Total. 181.86
.00 .00
181.86
BQPERMIT...
-
Permit #
DS- 517�.,-.7 >
Project Address:
A. P. Number:
Contractor: X ELT ; —
Address: .tr
Cite. ST, Zip: Y"
Telephone:
State Lic. # : X,pt
Arch.. Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: x
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs:
Truss Coles.
Title 24 CIIles.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE:.
Planning Approval
Pub. Wks. Appr.
School Fees
QY Of La Quinta'*
Building ar Safety DWIon
P.O. Box 1504, 78.4 P5 Calle Tampico
La Quinta, CA P2253 - (760) 777.7012
Building Permit Application and Tracking Sheet
Owner's Name: X
Address: X _
City. ST. Zip: K t' CA <
Telenhn— v.
C)
Lic. #:
Project Description: X
02O,arO
Construction Type:. Occupancy:
Si:f, pI p`NQBt� iC/ �-E/h- BAJ—
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Total Permit Fees
rrglect type (circle one):
New Add'n Alter
Repair Dem
C
.iE
Sq. Ft.:
#Stories:
Units:
C'
Estimated Value oPProject: X
/ 00 tr 09U
APPLICANT: DO NOT WRITE BELOW THIS
LINE
Recd
TRACKING
PERMIT
FEES
Plan Check submitted
0 2
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
7�.
Plans resubmitted
Alcchanical
2"+ Review, ready for corrections/issue
Electricalko3=�
Called Contact Person
Plumbing
lqp
— 4-1=1_6
Plans picked up
S.M.I.
Plans resubmitted
Grading
''' Review, ready for corrcctio/sue
Developer Impact Fee
Called Contact Person
A 1 P P.
Date of permit issue
Si:f, pI p`NQBt� iC/ �-E/h- BAJ—
�l Poor ► ,acs ken, IT
Total Permit Fees