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RPL (04-4123)77270 Loma Vista 04-4123 BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760).777-7012 78-495 CALLS TAMPICO FAX (760) 777-7611 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . ._-04-00004123 Date 5/26/04 Property Address . . . . . __7_727-0—LOMA VISTA APN: 658-200-013-19 -25237 - Application description POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation 50000 Owner Contractor ALBERTINI SHIRLEY A BRYAN INVESTMENTS GROUP, INC. 77270 LOMA VISTA 39301BADGERSTREET, #200 NEWPORT.BEACH CA 92663 PALM DESERT CA 92211 WCC: STATE FUND WC: 00090762003 03/29/05 CSLB: 552140 06/30/06 CCC: B-053 ---------------------------------------------------------------------------- Permit . . . MECH POOL Additional desc Permit Fee. 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation 0 Expiration Date 5/26/05. Qty Unit Charge Per Extension BASE FEE 15.00. .1.00 9.0000 EA MECH(FURNACE <=100K 9.00 Permit BLDG POOL PERMIT Additional desc Permit Fee 414.50 P1an'Check Fee 269.43 .Issue Date Valuation . . 50000 Expiration Date 5/26%05 Qty .-Unit Charge Per Extension BASE FEE 252.00 25.00 6.5000 -.THOU BLDG 25;001-50,000 16.2.50 ----------------------------------------------------------------------------- Permit ELEC POOL PERMIT -RES Additional desc Permit Fee . . 45.00 Plan Check Fee.. 11.25 Issue Date Valuation 0 Expiration Date ... 5/26/.05 Qty Unit Charge Per p Extension . D MAY 2'7 2 s C9T1( of. L A c r P.O. BOX 1504 78-495 CALLE TAMPICO IIY VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-701 1 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 Application Number: ©qr— Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or En ' ' A dress: 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 Code, and my Licens rn YII fo a and effect. License glass License No. Date d Contractor fjs I /V h i Ll OWNER -BUILDER DECLARA N 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 Owner WORKERS' COMPENSATION DECLARATION .1 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 maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is s ed. My w rkers' compensation insurance carrier and policy number are - Carrier Cartier a {� Policy Number i) �� 11 9 [� c0 — Z06 3 _ 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 those provisions. Date S-2- Applicant WARNING: FAILURE TO SECUREO KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED OUSAND 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. I herebyaffirm under CONSTRUCTION LENDING AGENCY 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 IMPORTANT APPLICANT ACKNOWLEDGEMENT 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 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 dayd from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Date—5—Signature (Applicant or Agent): C�/� ��i� ��' Sr -� .•fids. r ..'. '� •.27rr. ;.�.d RYA„ ^s .�: .. Page 2 Application Number . . . . . 04-00004123 Date 5/26/04 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 5/.26/05 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 INSPECTI ON. Fee summary Charged Paid Credited Due Permit Fee Total 516.50 .00 .00 516.50 Plan Check Total 294.93 .00 .00• 294.93 Grand Total 811.43 .00 .00 811.43 J Ole Ole M::M . . . . . ..... .. M "Noll, 'M WALLS 5'r arHERs rryp) ON .......... WATER MATUf;M CONCRETE CAP AT +16" NO M - W -S 15Y ALI ME "TYP) OTHERS . ...... ... M", MIR 'u, M 0or Nka POOL EGUIPMENT VWX 00 -4 00 p WITH M. FE55LE TECH FINISH a P'M WALLS B( M OTHERS Myp) . . ... . ...... ........... 'in r WATER f=EAMJI;T-- CAP AT +16" VIALLS BY ww'f;mTE OTHERS (Typ) v "J DEL RIO 5614 5G.'FT- qTAupFn