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RPL (04-3564)49440 Loren Ct 04-3564 tiNSA BUILDING. & SAFETY DEPARTMENT BOX 1504 (760) 777=7012 tai T 78-495 CALLE'TAMP1Co FAX (760)777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153 BUILDING PERMIT----- - Application'Number 04-00003564.,--' Date 4/19/04 Property Address . . . . . . • 4`944`0 LOREN CT APN: 649-630-013-35 =29053 - Application description . POOL - RESIDENTIAL Property Zoning . . . LOW DENSITY RESIDENTIAL Application valuation 17.000 Owner Contractor LA QUINTA JEFFERSON FIFTY CALIFORNIA POOLS & SPAS 73155 FIDDLENECK P.O. BOX 1280 PALM DESERT CA 92260 COACHELLA CA 92236 (760)..398-:9222 WCC: STATE FUND WC: 04600061168 01/0.1/05 CSLB: 656128 10_/31/04 CCC.: C8 -C27. -C2'9-053 Permit MECH`'POOL• . Additional desc -Permit Fee 15.00 Plan Check Fee 3.75 Issue Date. Valuation 0 Qty Unit.Charge Per. Ektension BASE .FEE 15.00 Permit . . . . . . BLDG POOL PERMIT Additional desc Permit Fee180:00 Plan Check Fee 117.00 Issue Date Valuation 17000 Qty .'Unit.Charge Per Extension BASE FEE 45.00 15.ob 9.00.00 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 Qty Unit Charge Per. Extension BASE FEE 15.00 1.00 30.0000 EA 'ELEC PRIVATE SWIMMING.POOL 30.00 Permit PLUMBING P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number. _ O!Z— Applicant: Applicant's Mailing Address: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect n_F - Ineer . Architect or Engineer's Address: Lic. No.. t3UILUINU PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION d my I hereby Licenrvier se of perjury Mat I am licensed under Provisions of Chapter 9 (Oommenclng with Section 7000) of Division 3 of the Business and'Prolessionals License c "°ens° is C ane etrecL No w'v 17. Date-2 D L/ Contractor I hereby alum. under penalty of perjurythat I am OWNER -BUILDER DER DECLARATION city exempt from the CorUsctois' state License Law for the following ,eases, (Set 7031.5, Business and Professions Code: Any or Y that rogmimes a Pem b corhttrmrct. Nter. irnPnore. demolish or repair any strut M prior b ks issuance. also requires the appricant ter the pm* b fie a signed statement that he or she Is licensed pw=m t to the provisions of the Contrack". State I cense Law (Cfapter 9 (commencing 00) of Division Mind P10(assions with Section 70n 3 of to Business the Code) or that he or she is exempt V mekoran n d the basis ter the aaegee exemption. Any violation of Section 7031.5 by any appicarM ter permit subjects nt to dvl a U I. as owner a the penalty of not more than Eve hundred dollars ("W).X property. or my eR1Ployees with wages as their sob oompensabon, will do the work, and the structure is not intended or oNered ter sale (Sec. 7044. Business and Professkmu Code: The Contraobrs' State License Lew does not apply to an owner of property who bunds or improves thereon, and who does the work hirnselerself or trough his or her own employees, provided that the inprOvOmentS are not intended or offered for sale. It. however, the budding or mVrovmnent is within or Ona Year of . on exclu, the owneabmalder will have the louden Of proving that he or she did not build or improve for the purpose 0f sate.} (..) 1, as owner a the property, on exausively oontractir,p ,sith have contractors b construct the prood (Seo, 7044, Business and Professions Code: The Contractors' state License Law doe: not apply to an owner of property who the Conbecbrs' state License Law.). builds Or improves thereon, and who contracts for the Projects with a cantraCtor(s) licensed pursuant to U 1 am exempt under Sec . BA P.C. for this mason Dab Owner 1 hereby affirm under penalty dperjury WORKERS' COMPENSATION DECLARATION perjury ora Of the following declarations: _ I hove 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 wl dd this Pa., is Issued. _ I have and will maintain workers' compensation insursnce, carrier as required by Section 3700 of the Labor Code. for the performance of the work ter which this peril is CarderkwAwm Number !J !o C _ My I Catty Mat, In the pertorrnance of the work for which this permit is issued. I shah employ any person in any manner so as to bacon subject b the workers' tam y and ap ee flat, Y 1 should become subOd b the workers! compensation provisions of section 3700 of the Labor Code. I shwa Date L% V gppCrcara C h 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 ADD ON TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE. pnMREST, AND ATTORNEY'S FEES. . I hereby affirm underCONSTRUCTION LENDING AGENCY PenekY d perjury that them is a 00rshudion landing agency for the performance of the work for which this permit is issued (Set 3097. Civ. C.). Lender's Name Lenders Address IMPORTANT Application le hereby made b the Director of APPLICANT ACKNOWLEDGEMENT Building and Safety ter a Permit subject b the conditions and restrictions set IDd h on this appicatvm 1. Each Person upon whose behalf this application is made. each Person at whose request and for whose benefit work is performed under or pursuer* to any permit Issued as a result of this appicstion. the owner. and Mhe applicant, each agrees b, and shall, defend. kxlemrhify and hold harmless the City of La Quints, Its agars and employees for any ad or omission related to the work being performed under or following 2. Any permit issued as a mutt of this appication becomesnus and void k work is not commenced within ayss from dateofissuance of such pertrmit, or _ cessation of work for 1110 days will subject permit b cancellation. Iiat I end fired t he" read his epP nand stat eof Minis that the above Information is Correct. I agree b comply with as city and county ordinances and state laws relating b building county to enter the above-mentioned property for inspection purposes. Data / !'G Signature (Applicant or Agent): . Page. 2 Application Number 04-00003564 Date 4/19/04 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 ONLY. ALARMS BARRIERS SHALL BE IN PLACE PRIOR. TO PREPLASTER INSPECTION. Fee summary Charged Paid Credited Due Permit Fee' Total 273.00 .00 .0 273.00 Plan Check Total 140.25 .00 .00 140.25 Grand Total 413.25 .00 .00 413.25.