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.