RPL (04-4891)50440 Los Verdes Way
04-4891
T.Vf 4 4 a"
BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 (760).777-7012
78-495 CALLS. TAMPICO FAX (760) 777-701 1
i A QUINTA; CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
Application Number . . .
Property Address . . . .
APN:
Application description .
Property Zoning . . . . .
Application valuation
BUILDING PERMIT
\'Q4 000048-91' Date 6/•11/04
_:"_5.0440 LOS VERDES WY
.772-250-999-99 -30357 -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
15000
Owner Contractor
LEET PICAS SO POOLS, INC
50440 LOS VERDES WAY 78078 COUNTRY CLUB DR, #206
LA QUINTA CA 92253 PALM DESERT CA 92211
(760) 345-4600
WCC: STATE FUND
WC: 1709395. 12/01/04
CSLB: 81011 11/20/04
CCC: C27 -053-B
---------------------------------------------------------------7------------
Permit . . . . . BLDG -POOL PERMIT
Additional desc
Permit Fee 162.00 Plan Check Fee 105.30
Issue Date Valuation .15000
Qty Unit Charge Per Extension
BASE FEE 45.00
13.00 9.0000 THOU BLDG 2,0.01-25,000 117.00
--------------------------------------
Permit . . . . MECH POOL
Additional desc
Permit Fee . . . . 24.00: Plan Check Fee 6.00•
Issue Date . . . . Valuation . . 0
Qty Unit Charge Per Extension
BASE. FEE 15.00
1.00 9.0000 EA MECH FURNACE <=100K 9.00
-----'-----------------------------------------------------------------------
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
1.0,0 30.0000 EA.. ELEC PRIVATE SWIMMING'POOL 30.00
P.O. BOX 1504 C&If 4 4 a"
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: 04- q /
Applicant: I Architect or Engineer:
Applicant's Mailing Address: •
VOICE (760) 777-701_
FAX (760) 777-701
INSPECTIONS (760) 777-715?
Date:
Architect or Engineer's Address:
i -VA
Lic. No..
BUILDING PERMIT DECLARATIONS
I hereby affirm under penaltyof LICENSED CONTRACTOR'S DECLARATION
Perjury that I am licensed under provisions of Chapter 9 (commenong with Section 7000) of Division 3 of the Business and Professionals
Code,
and my l, ce in II f aeftect. // / J
nse Clas s /T^ ^ License No.
i Date v a I/
0
I hereby affirm under penaltyof OWNER -BUILDER DECLARATION
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).):
(--) I• as ownet 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 improvefor 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 contractors) licensed pursuant to
the Contractors' State License Law.).
U 1 am exempt under Sec. . B.d P.C. for this reason
Date Owner
I herebyaffirm under WORKERS' COMPENSATION DECLARATION
penalty of perjury one of the following declarations:
1 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 peAorinance
of the work for which this permit is issued.
I have and will maintain workers' co
mpensationn surance, as required by Section 3700 of the Labor Code. for the performance of the work for which this permit is
/ issued. (vFp compensation in ce carrier and policy num rare:
Carried'( RTS j olicy Number
• _ I
certify that, m 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
ort comply with those p iswris.
/date
Applicant
WARNI F ILURE TO SECURE WORKERS' COMP SATION 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.
I hereby affirm under penalty of perjury that there is a construction lending
agency
y for the Performance ma AGENCY
Of
he work for which this
g 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 Witita, 45
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 days from date of iasuantx of such permit w
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this applicatiori and state that the above infoimation is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, nd he by authonze repr ntatives of this "loent.,on the above-rtmentioned roP Petty for inspection purposes.
ate ignature (Applicant or Agen
Page
2
Application Number . . . . .. 04-00004891 Date
----------------------------------------------------------------------------
6/11/04
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 3.0.000 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
----------------- ----------
Permit Fee Total 264.00
Plan Check Total 130.80
Grand Total 394.80
Paid Credited Due
---------- ---------- ----------
.00 .00 264.00
.00 .00 130.80
.00 .00 394.80
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HEATER:
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EXTRA OUTLETS:
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AUTO -FILL:
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GAS LINE:
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STUB OUTS:
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CASCADES:
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SPA LIGHTS:
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2nd STEP:
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TILE TYPE::
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WATERLINE:
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TILE TRIM:
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RBB TILE:
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EXTRA JOINTS:
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SUB BASE:
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VISQUEEN:
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STAMPED:
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P/L EXT WALLS:
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PLANTER WALLS:
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RETNG WALLS:o
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EQ WALLS:
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GATE TYPE:
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R&R GATE:
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SIZE:
BBQ MODEL:
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TOP FINISH:
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SIDE BURNER:
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FACE FINISH:
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PEN LIGHT:
PLUG OUTLET:
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LIGHTS SWITCH:
PLASTER
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PLASTER COLOR:
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PEBBLE COLOR:
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POOL LIGHTS:
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SPA LIGHTS:
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ROLLED BOND BEAM:
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EYEBALLS:
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OTHER
Z Q
PLAN FOR
o 1-- CD
RESIDENCE
ADDRESS: 504W LOS VERDES WAY
_LA QUINTA
1-07-#99 TRACT#
REVISIONS:
(1)
DATE:
(2)
DATE:
(3)
DATE:
Date Printed ( 8= ' S ca I e
12:59 PM 6/9/04
I'TTZ'1 1 171
Drawing by: JUDY