BPOL2015-013278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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4a
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
' Application Number:
BPOL2015-0132
f ( Property Address:
80811 VISTA LAZO
APN:
762250016 ^
Application Description:
BULEN / POOL SPA AND FIRE PIT
Property Zoning:
Application Valuation:
$50,000.00
Applicant:
MC INTYRE POOLS & SPAS INC 4
83-695 AVENUE 45
INDIO, CA 92201,
-----------------------------------------------
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 Professions Code,
and my License is in full force and effect.
License Class: C53 License No.: 614611
Date / � �% 5 Contractor'
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.).
(� 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. . B.&P.C. for this reason
Date: Owner:
i
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjurythat there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Na
Lender's
P
VOICE (760) 777-7125
FAX (760)777-7011
.IN5PECTIONS (760) 777-7153
Owner: "
R BULEN
P 0 BOX 115
LAKE ELSINORE, CA 0
Contractor:
MC INTYRE POOLS & SPAS INC
83-695 AVENUE 45
INDIO, CA 92201
(760)342-3612
Llc. No.: 614611
Date: 6/26/2015
----------------- - - - - - -
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 woik 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: _ 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 Labor Code, I shall forthwith
comply with rhos prov 5ions.
Dal/ Applicant i!%Gy- —
f
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 Building Official 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 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 law�upe
uilding
construction, an her by authorize representatives of this city to enabove
-
me erty or inspection purposes:
Date v r/� Signature (Applicant or Agen
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----------------- - - - - - -
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 woik 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: _ 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 Labor Code, I shall forthwith
comply with rhos prov 5ions.
Dal/ Applicant i!%Gy- —
f
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 Building Official 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 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 law�upe
uilding
construction, an her by authorize representatives of this city to enabove
-
me erty or inspection purposes:
Date v r/� Signature (Applicant or Agen
;7AU
,
t
INFORMATIONE
DESCRIPTIONfws
�:"ACCOUNTS'QTY
��PAID PAID DATFINANCIAL
rs�AMOUNT?}}
BSAS SB1473 FEE
101-0000-20306 0
$2.00 $0.00
* i,"wPAID BY a + '
u r
;� METHOD? $ +f RECEIPT# ' k uCHECKk#77 CLTU BY';
r., t
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $2.00 $0.00
QTYF
t AMOUNT
� ` PAID, � _` '�+
;PAID DATE
a
„
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.09
$0.00
y , ,PAID BY �� ``+j 4V;;r � a
cMETHOD
`az;:ItECEIPT#
�; ICHECK#u
CLTD:BY
:
�� r4
�,I;DESCRIPTION �A x,,� ��'
zACCOUNT �y
dim AMOUNT Fir'?kPAIDrr��
�`'
PAID'DATE"
i
r`t
,QTY
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$24.17
$0.00
�.
^PAID
METHOD'CHECK
# �' �:t
CLTD BY,
Total Paid for PLUMBING FEES: $36.26 $0.00
rt4DESCRIPTION
i., -ACCOUNT }} ��"
' AMOUNT,% ;'
�"r'jPAIW
�PAID.DATE
w k
.
yCITY
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
$0.00
i? MAID BY.,1 i.•
`:,' METHOD '+"
* RECEIPT;#a r
CHECK#Y�
CLTD.BY
+ ;
r �'
r� t;
.x T M .':
DESCRIPTION �; '$M'
r `r} * -'F '
s AMOUNT
'C X: PAID• 'sfr
PAID`DATE:
k:
rAC000NT r`
,QTY
SWIMMING POOL/SPA PC
101-0000-42600
0
$98.62
$0.00
'PAID BY
"
-!.i -,—`METHOD
CLTD.
. •.
.... ,..CHECK#
Total Paid for POOL/ SPA: $279.91 $0.00
TOTALS: 0•
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ADDITIONAL
CHRONOLOGY
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"CIiRONOLOGY TYPES - ^:STAFF NAME ? """'ACTION DATE" s COMPI ETION DATE c ` P
{fes a._a , i..._ trlcrF-d xz" +x ,3 s.�u
NOTE
MARY FASANO
6/26/2015
6/26/2015
FINANCIAL INFORMATION
CONDITIONS
CONTACTS
4 -
. NA.METYPE;M}y4 . ;,5��, , �,: NAME¢;+r� ��, .�.,,(}� ,,. ADDRES51•s�c .,� CITY ,�,_�y''{�`� w�STATE,
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APPLICANT
MC INTYRE POOLS & SPAS INC
83-695 AVENUE 45
INDIO CA
92201
CONTRACTOR
MC INTYRE POOLS & SPAS INC
83-695 AVENUE 45
INDIO CA
92201
J i
OWNER
R BULEN
P O BOX 115
LAKE ELSINORE CA
0
Printed: Friday, June 26, 2015 4:16:49 PM 1 of 2 f CBTWSYSTEMS
FINANCIAL INFORMATION
Printed: Friday, June 26, 2015 4:16:49 PM 1 of 2 f CBTWSYSTEMS
BOND INFORMATION
ATTACHMENTS
Printed: Friday, June 26, 2015 4:16:49 PM 2 of 2 cb?w"YSTEMS
QTY
41
P
u,p I f
ECEIPT4�v
�:CH
-CHECK
;`-'METH 6"
PAID B
`X-
BSAS SB1473 FEE
101-0000-20306
0
$2.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$2.00 $0.00
BSA:
GAS SYSTEM, 1-4
101-0000-42401
0
$12.09
$0.00
OUTLETS
GAS SYSTEM, 1-4
101 -0000-42600
0
$24.17
$0.00
OUTLETS PC
Total Paid forPLUMBING FEES: $36.26 $0.00
.SWIMMING POOL/SPA
101-0000-42404
0
$181.29
SWIMMING POOL/SPA
101-0000-42600
0
$98.62
$0.00
PC
Total Paid for POOL/ SPA. $279.91 $0.00
TOTALS: $318.17 $0.00
BOND INFORMATION
ATTACHMENTS
Printed: Friday, June 26, 2015 4:16:49 PM 2 of 2 cb?w"YSTEMS
Bin # City of La Quinta.
Building u Safety Division
Permit # P.O. Box. 1504, 78-495 Calle Tampico
La Quinta, CA 92253 (760) 777-7012
1
sL
PbL20' 3�-- Rbilding Permit Application and Tracking Sheet
ProjectAddress: 0�2 Owner's Name: CAP0
/ .
A. P. Number: Address: 6 ) — l U t S k( C_
Legal Description: City, ST, Zip: y
Contractor:C_Jv1S S Telephone:'
Address: — 0 S Project Description: j
City, ST,.Zip: C );VI. C14 w 20 1.
f Telephone: 7ff) — 9 a.-36 .
State tic. #: C 53 - 61, Lf e i I City Lic:
Arch:, Engr., Designer. .. .
Address:
City.; ST, Zip:
li
Telephone: Construction Type: Occupancy:
1.
r. State laic. #:�x projecYtype (circle one): New Add'n Alter Repair, Demo
Name of Contact Person: eike
#Stories: #.Units:
EqFtW
Telephone # of Contact Person: U — S ed Value of•Project:0. V
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cates.:
Reviewed, ready for corrections Plan Check Deposit
Truss Cates.
'.Called Contact Person Plan Check Balance
Title 24 Cates.
I.Planspickid
up Construction
Flood plain plan
Plans resubmitted . Mechanical
Grading plan
tad Review, ready for correctionsfissueElectrical
Subcontactor List
Called Contact Person Plumbing.
Grant Deed
Plans.picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN.HOUSE:- .
''a Review, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person A.LP.P.
Pub. Wks. APpr
Date of permit issue
School Fees
Total Permit Fees
;K;r