08-1112 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08-00001112
Property Address: 81857 VIA SAN CLEMENTE
APN: 764-010-008-7 -31910 -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 23000
Applicant:
Or
Architect or Engineer:
PIP
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am Ii nsed un.Ar provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and P fession Code, and my License is in full force and effect.
License Class: C53 cense No.: 614611
_offDate: ontractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjur 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 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 1, 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.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
WOODLAND
81857 VIA
LA QUINTA,
SAN CLEMENTE
rA 92253
Contractor:
MCINTYRE POOLS &
83695 AVENUE 45
INDIO, CA 92201
(760)342-3612
LiC. No.: 614611
VOICE (760) 777-7012
FAX (760) 777-701 1
INSPECTIONS (760) 777-7153
Date: 6/27/08
i
t r�{
JUL 01
SPAS I[Cl
.TY OF LA OeINTA
FINANCE
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 DELOS INS CO Policy Number 01DKRM12001870
I certify that, in the performance of the work f which this permit is issued, I shall not employ any
person in any manner so as to come s j ct to the workers' compensation laws of California,
and agree that, if I should be me subj o the workers' compensation provisions of Section
3700 of the La r Code, I s II fort comply with those provisions.
;et -e: licant:
WARNING: FAILE 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 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 pacessationf work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the aborrect. I agree to comply with all
city antl co my .ordinances and s[ to laws relating to building reby authorize representatives
of this my to enter upon th bove-mentioned property for.
I
e:-7 / —G Si ture (Applicant or Agent):
Application Number . . . . . 08-00001112
.Permit . . . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 234.00 Plan Check Fee 152.10
Issue Date . . . . Valuation 23000
Expiration Date 12/24/08
Qty Unit Charge Per Extension
BASE FEE 45.00
21.00 9.0000 THOU BLDG 2,001-25,000 189.00
Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 12/24/08
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 12/24/08
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 . . 12/24/08
•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
----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
LQYERMIT
Application Number . . . . . 08-00001112
----------------------------------------------------------------------------
Special Notes and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMET ENCLOSURE NOT INCLUDED.
Fee summary Charged
----------------- ----------
Permit Fee Total 338.00
Plan Check Total 178.10
Grand Total 516.10
I,QPEPAI IT
Paid Credited Due
---------- ---------- ----------
.00 .00 338.00
.00 .00 178.10
.00 .00 516.10
Bin #
City of aQ uinta . .
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
U Quints, CA 92253 - (7¢0) M-7012-
Building Permit Application and Tracking Sheet
Permit #
Project Address; S V V I .' 'Q
Owner's Name: . Q 2
A. P. Number:
Address:. 9115-7-Vi-q. S cn 197 en
Legal Description:
City, ST, Zip:
nn
Contractor: e /Ud
Telephone:
Address: 83 6
*:Project Description: .Pild 5
City, ST, Zip:. Pc 7_70
Telephone:
State Lie. # : 053— 6
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lib. #:
Name of Contact Person:, P - F!
Construction Type: Occupancy:
cy:
Project type (circle one): New Add's Alter Repair Demo
Sq. Ft.
#Stories:
#Units:
Telephone # of Contact Person: — (
Estimated Value-of Project: p!
APPLICANT:
DO NOT WRITE BELOW THIS UNE .
#
Submittal
Req'd
Recd
TRACKING
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
Constructioc.
Flood plain plan,
Plans resubmitted
Mechanical
Grading. plan'
2°" Review, ready for correctionsrissue
Electrical
SubcontactorList '
Called'ContactPerson
Plumbing
GranfDeed
Plans•picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading.
IN HOUSE:
'nd Review, ready for correetions;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