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RPL (04-5301)78910 Lima St 04-5301 Application Number x-04-000053.014Date 7/01/04 Property Address 78910 LIMA APN: 772-102-009- T - Application description . . . POOL - RESIDENTIAL Property Zoning . . . . LOW DENSITY RESIDENTIAL Application valuation 17000 ` Owner Contractor SIMMONS BILLY W- CALIFORNIA POOLS & SPAS P O BOX '376P.O. BOX 1-280 CALIMESA CA 92320. COACHELLA CA 92236 (760) 398-9222 WCC: STATE FUND WC: 04600061168 01/01/05 CSLB: 656128 10/31/04 CCC: C8 -C27 -C29-053 Permit . . . BLDG POOL PERMIT .Additional desc Permit Fee . . . . 180.00 Plan Check Fee 117:00. Issue Date . . . . Valuation 17000 Qty Unit Charge Per Extension BASE FEE 45.00 15.00 9.0000 THOU BLDG 2,001-25,000 135.00 Permit . . . .. MECH POOL Additional desc Permit Fee . . . . 24.00- Plan Check Fee 6.0.0 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension . BASE FEE 15. 0,0 1.00 .9.0000 EA MECH FURNACE <=100K 9.00 - - - - - - - - - - - - - - - - - - - - - - - - - - ------------------------ -------- - - - - - - - - - - - - - - - - - Permit . . . . . . ELEC POOL PERMIT -RES Additional desc 1� Permit Fee . . . . 45.00 P1196n CMh ck Ft,_ut- 11.25 Issue Date . . .aat� VaN 0 Qty Unit Charge Per �� Extension BASE FEE F�� 15.00 1.00 30.0000 EA ELEC PRIVATE-SWIMM_ING POOL 30.00 P.O. Box 1504 78-495 CALLS TAMPICO ��/�G� Y VOFAX (760) 777-7011ICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0 U - .6-3 G / Date: Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS I hereby affirm under penalty of perjury that I am licensed under Lode, and my Lice r04e isAfp5 force and effect J License Class r j i mon S DECLARATION ker cing with Section 7000) of Division 3 of the Business and Professionals V[2cto BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the C tracto 8 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.). (, 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 Owner WORKERS' COMPENSATION DECLARATION .l 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 is permit is issued. 1� I have and will maintai orkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is is a My workers compensatio�n i�r 5u�rance carrier a d icy number a : �rrier —PolicyNumber (7ft Ay I certify that, in the performance of the work for which thi p rmit is is ed, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomi and agree that, ' sh ul become ubject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pr i ions. /Date L d p�t WARNING: FAILURE TO SECURE WORKS S' COMPENSATION COQEIS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,00DITION 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 Lender's 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. 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 bein ed under or fallowing issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work'not ce enced 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 inf 'nation is coriove�entio Iree to mply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county ter upon t�(e property for inspection purposes. ate ignature Applicant or Agent): Page 2 Application Number . . . . . 04-00005301: Date 7/01/04- ' Permit . . . PLUMBING Additional. desc Permit Fee 33:00 Plan Check Fee 8.25 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 Special Notes and. Comments POOL/SPA.ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE.NOT INCLUDED Fee summary Charged Paid Credited Due ----------------- ---------- ---------- Permit Fee Total 282.00 .00 .00 282.00 Plan -Check Total 142.50 .00* .00 142.50 Grand•Total 424.50 .00 .'00 424.50