08-0978 (RPL)P.O. BOX 1504 4
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 08-00000978 Owner:
Property Address: 51905 VIA ROBLADA VALDEZ RESIDENCE
APN: 772-270-010- - - 51-905 VIA ROBLADA
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 26000
Contractor:
Applicant: Architect or Engineer: MCINTYRE POOLS & SPAS, INC.
83595 AVENUE 45
INDIO, CA 92201
(760)342-3612
Lic. No.: 614611
LICE SED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that IT
li sed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business nd P essionals Code, and my License is in full force and effect.
License Class: C53 / License No.: 614611
Date: 6"� d� Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of p jury 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, 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 throughhisor 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.l.
(_ 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 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:
- Lender's Address:
LQPER,\11T
-70
INSPECT' S (760) 777-51;'3+
JU o o ��J
6/09 0
CITY OF LA ouni ,
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.
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 DELOS INS CO Policy Number 01DKRM12001870
I certify that, in the performance of the
for which this permit is issued, 1 shall not employ any
person in any manner so as to com bject to the workers' compensation laws of California,
and agree that, if I should bec e s ct to the workers' compensation provisions of Section
3700 of the Labor Code, I s I for ith comply with those provisions.
Date: Il(-9f6Y Applicant:
WARNING: FAILURE TO SECURE KERS' 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 Ouinta, 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 th0-veation is correct. I agree to comply with all
city and county ordinances and state laws relating toon, and hereby authorize representatives
of this county to e(ntter upon the above-mentioned prn purposes.
Date: 6- 9-6 V Signature (Applicant or Age
Application Number . . . . . 08-00000978
Permit . . .
MECH POOL
Additional desc . .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
12/06/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
----------------------------------------------------------------------------
EA MECH FURNACE >100K
11.00
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
258.50 Plan Check Fee
168.03
Issue Date . . . .
Valuation . . .
. 25760
Expiration Date . .
12/06/08
Qty Unit Charge
Per
Extension
BASE FEE
252.00
1.00 6.5000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
6.50
Permit . . . . .
ELEC POOL PERMIT -RES
Additional desc . .
Permit Fee . . . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
12/06/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
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 . .
12/06/08
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
Permit . . . . . . WALL/FENCE PERMIT
LQYE%NI IT
Application Number . . . . . 08-00000978
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 15.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 240
Expiration Date . . 12/06/08
Qty Unit Charge Per
Extension
BASE FEE
----------------------------------------------------------------------------
15.00
Special Notes and Comments
POOL, SPA, ALARMS/BARRIES SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION. 15 L.F.
X 4' HIGH CITY STANDARD BLOCKWALL.
Fee summary Charged Paid
-----------------
Credited
Due
--------------------
Permit Fee Total 377.50
----------
.00
----------
.00
377.50
Plan Check Total 194.03
.00
.00
194.03
Grand Total 571.53
.00
.00
571.53
LQPERA1IT
Telephone # of Contact Person:
# Submittal Re
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan,
Grading. plan
Subcontactor List
Grant Deed
I-LO.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City O La Ouinta
Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta CA 92253 - 17AOI 777-7012
Building Permit Application and Tracking. Sheet
<�
Owner's Name:
Address: 5 i Q 5Irl
U)
City, ST, Zip: Ire C
Project Description: .
Lie. #:
Project Address:
A. P. Number:
T Project type (circle one): New Add'n Alter Repair Demo
CJC:i►� Sq. Ft.: #Stories: #Units:
c5 — g6 r✓ Estimated Value of Project 216 o Gc— /, 0*0
APPLICANT: DO NOT WRITE BELOW THIS LINE .
Legal Description:
Contractor:
Address: 1
PERMIT FEES •
City, ST, Zip:. 1446
11
Telephone: 4 _
Lie. #
, Engr., Designer:
r
ss:
Amount
City, ST, Zip:
Telephone:
State Lit. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal Re
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan,
Grading. plan
Subcontactor List
Grant Deed
I-LO.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City O La Ouinta
Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta CA 92253 - 17AOI 777-7012
Building Permit Application and Tracking. Sheet
<�
Owner's Name:
Address: 5 i Q 5Irl
U)
City, ST, Zip: Ire C
Project Description: .
Lie. #:
Total Permit Fees
Aye
,5 ?60
'.
Construction Type: Occupancy:
T Project type (circle one): New Add'n Alter Repair Demo
CJC:i►� Sq. Ft.: #Stories: #Units:
c5 — g6 r✓ Estimated Value of Project 216 o Gc— /, 0*0
APPLICANT: DO NOT WRITE BELOW THIS LINE .
I'd
Recd
TRACKING. i
PERMIT FEES •
Plan Check submitted
Q
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2nd Review, ready for correctionslissue
Electrical
Called Contact Person
Plumbing
Plans. picked up
S.M.I.
Plans resubmitted
Grading
Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees
Aye
,5 ?60