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05-0284 (RPL)S 4 T.Vf 4 4 Q" BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . C0=5'0=0=0=0.0.2-8,1 Date 1/28/05 Property Address . . . . . . 80057 RIVIERA APN: 76.2-120-007- - - Application description . . . POOL'- RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 18000 Owner -- Contractor =- - - - - - - - - - - - - - - - - - - - TOLL BROS - -- ------------------ CALIFORNIA POOLS & - - - - SPAS 80-057 RIVIERA A .0. BOX 1280 LA QUINTA 3 CA 92236 �COACHELLA x(760) 398-9222 FEB 0 12005 CC: SEABRIGHT INS WC:. BB1050510 01/01/06 CITY OF LA QUINTA C S LB : 656128 10/31/06 FINANCE DEPT. - CCC: C8 -C27 -C29-053 ----------------------------------------------------------------------------- Permit . . . . BLDG POOL PERMIT Additional desc Permit Fee . . . 189.00 Plan Check Fee 122.85 Issue Date . . . . Valuation . . . . 17920 Qty Unit Charge Per Extension BASE FEE 45.00 16.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 144.00 Permit . . . . . . MECH POOL Additional desc Permit Fee 24.00 Plan Check Fee 6.00 .Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 ---------------------------------------------------------------------------- EA MECH..FURNACE <=100K 9.00 Permit ELEC•POOL PERMIT -RES Additional desc Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date . . . Valuation 0 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 P.O. BOX 1504 '�C�� 78-495 CALLE TAMPICO VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 4 4 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: 02 • / • O r Applicant: I Architect or Eri Applicant's Mailing Architect or Engineer's Address: N I /T Lic. No.: tsUILUING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed and provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals ode, and my Licease i;iwfull force and effect. �5 License Class C— c� � icer a No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U 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 or 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.). U 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.). U I am exempt under Sec. , BA P.C. for this reason Date WORKERS' 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 mainta' workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is i e Ay wort compensation insurance carie�an p licy num.1, Cartier er _ I certify that, in thd performance of the work for which ttff permit 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, I ould be co a subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provi�ns. / ate �0,9Applicant w j WARNING: FAILURE TO SECURE WORKERS' COMPENskrf0N GE 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. 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 Lenders Address 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, indemnity and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission related to the work ' performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if ork is of 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 C, I ato comply with all city and county ordinances and state laws relating to building �co�nstructiioonn. and hereby authorize representatives of this county to'enter upon a v6:1fioned property for inspection purposes. 'oar, �G / Signature (Applicant or Agent): IA. 0 Page 2 Application Number . . . . . 05-00000281 Date 1/28/05 Issue Date, Valuation . . . . 0 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 Additional desc Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date Valuation . . . . 80 Qty Unit Charge Per Extension BASE FEE 15.00 -..-----------------.----------------------------------------------------------- Special Notes and Comments POOL & SPA. BBQ ANSI #Z21581995. 5 LF OF 4' BLOCK WALL PER CITY STANDARD. .ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. Fee summary Charged Paid Credited Due ------------------------------------- Permit Fee Total 306.00 ---------- .00 .00 ---------- 306.00 Plan Check Total 148.35 .00 ..00 148.35 Grand Total 454.35 .00 .00 454.35 X� t , i t ! .� -r�,� 1 �i (-� y �. � �'� GST (�' �t � � d :. t �t� �� i1, h� �y E �» X� t , i t ! .� -r�,� 1 �i (-� y �. � �'� GST (�' �t � � d :. t �t� �� i1, h� �y E