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05-0111 (RPL)t O� BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 8- LLE TAMPICO FAX (760) 777-7011 A, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 JAN 131005 BUILDING PERMIT rTM OF L4 wry, _ Applicatio - r . . . . . Q5 _0=_0__00-0-1-1-1-- Date 1/11/05 Property Address . . . . . .X5 28_7.0—AV-ENIDA---MON-T-EZUMA--J APN: 773-311-006-21 -000000- Application description... POOL - RESIDENTIAL Property Zoning . . . . . . . COVE RESIDENTIAL Application valuation . . . . 17000 Owner Contractor ------------------------------------------------------------------ BUFF CALIFORNIA POOLS & SPAS 52-870 AVENIDA MONTEZUMA P.O. BOX 1280 LA QUINTA, CA 92253 COACHELLA, CA 92236 (760)398-9222 WCC: STATE FUND WC: B31050510 01/01/06 CSLB: 656128 10/31/0'6 CCC: C8-C27-C29-053 ---------------------------------------------------------------------------- P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: A t6y Architect or Engineer: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS 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 ode, and Licensejg in cue and effect. / Z License Class � � 0,--. (>I/ ate 2—Z" ontm for 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 Secfion 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 j, 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 h ve an o will m ' tain rs' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ssue y rkers' C."'00. nsation insurance carrier j�9M�� n b are:p� /' CarrierPolicy Number a �L� �y 2l _ I certify that, in the pert ance of the work for w ' s perm is issued, I shall note y any person in any manner so as to become subject to the workers' compensation laws of California, and agree th if I s uld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those proYis�jans. WARNING: FAILURE TO SECURE WORKERS' COMPEN%vrm6N 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. 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, 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 v/thabpinfioned 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 a to comply with all city and county ordinances and state laws relating to building construction, n7d hereby authorize representatives of this county to a ter upon property for inspection purposes. Date �Z2Zo�nlS-ig� licant r (PP o Agent): ------------------------------------------------------------------------- Application Number 05-00000111 tw Permit . . . . . . MECH POOL Additional desc Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date Valuation . . . . 0 Expiration Date 7/11/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 ---------------------------------------------------------------------------- Permit . Additional desc Permit Fee . . . . Issue Date . . . . Expiration Date . . BLDG POOL PERMIT RMNIrmere 7/11/05 Plan Check Fee . . 117.00 Valuation . . . . 17000 Qty Unit Charge Per Extension BASE FEE 45.00 15.00 9.0000 -------------------7-------------------------------------------------------- THOU BLDG 2,001-25,000 135.00 Permit . . . . . . ELEC POOL PERMIT -RES Additional desc . . Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/11/05 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 7/11/05 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 ONLY. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged ----------------- ---------- Permit Fee Total 282.00 Plan Check Total 142.50 Grand Total 424.50 Paid Credited Due ---------- ---------- ---------- .00 .00 282.00 .00 .00 142.50 .00 .00 424.50 os CITY e T 5 -w BUILDING &' TY D P Ft�Tf�lE 7 12•�� P INSPECTIO UE pEP 77 71 G�NPNG Owner purr ✓ i Contractor C-AIAR>< TI�AA- (�III;S &SPAS Permit Number 05-0111 j POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 52470 AVENIDA M0I4TEZUMA POOL & SPA ONLY. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN INSPECTION DATE INSP. TEMPORARY POWER SETBACKS U/G PLUMBING /WASTE U/G ELECTRICAL/ GROUNDING FOOTINGS / STEEL CONCRETE SLAB DO NOT POUR CONCRETE UNTIL AE ROOF NAIL / PRE -ROOF OKAY TO WRAP FRAMING COMBINATION ROUGH ELECTRIC_ ROUGH PLUMBING -ROUGH MECHANICAL NSULATION COVER NO WORK UNTIL ABOVE NTERIOR GYP. BD. DRYWALL XTERIOR LATH 3AS TEST SEPTIC ABANDONMENT SEWER CONNECTION SEPTIC / GREASE INTERCEPTOR SIGNED MASONRY INSPECTIONS :OOTINGS / STEEL 3OND BEAM POOL / SPA / WATER FEATURE INSPECTIONS 'RE-GUNITE / SETBACKS` Q J/G PLUMBING J/G GAS J/G ELECTRICAL 'RE -PLASTER (ALARMS/ BARRIERS - -Q FINAL INSPECTIONS TEMP. USE OF PERMANENT POWER LECTRICAL 'LUMBING V MECHANICAL 'UBLIC WORKS DEPARTMENT 3OMMUNITY DEVELOPMENT DEPT. :INAL / JOB COMPLETED - 1 . n I 'L I . �MININILIVi Oi- ";.'.i'.t3�.!`.C3V! WEEP SCRG&Z.... m