RPL (04-4688)50470 Los Verdes Way
04-4688
s
+ j 1 ^ g IVIf 7 N • .
BUILDING & SAFETY DEPARTMENT
rRAULC 4F 04 (760),777,7012
FAX (760) 777=7011
` OF LE AMPICO
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
4 Application Number04-00004688 Date 6/01/04
.Property Address .50470 LOS VERDES WY
APN: 772-250.-999-96 -30357 -
. . :• Application description POOL - RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
App.l.icaton valuation. 65
Owner Contractor.
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TOLL CA V CALIFORNIA' POOLS & SPAS
C/O •KEVIN. D DUERMIT P.O. BOX 1280 .
.'8 9'0.1: E. MOUNTAIN' VIEW 200. ! COACHELLA. CA .92236
SCOTTSDALE AZ 85258. ,(760) 39.8-9222
WCC.: STATE FUND
WC: 04600061168 ..0.1/01/05
CSLB.: 65612.8 10/31/04
CCC:. C8 -C27. -C29-053
Permit MECI4 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 BLDG POOL -PERMIT
Additional desc..
Permit Fee 189..00. Plan Check Fee 122.85
..:..T.ssue Date Valuation1 .000
Qty Unit Charge Per Extension
BASE .-FEE
.45'.00
16..00 9.0000 THOU BLDG 2,001'-25;000 1-44:00
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
7V i7N
P.O. Box 1504 VOICE (760) 7 -77 -'7'07P2-
78 -495
77-70b278-495 CALLS TAMPICO .. : FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
. BUILDING & SAFETY DEPARTMENT
Application Number: 0 /, 411 g Date:
Applicant:
Applicant's Mailing Address:
Architect or Enginee .
Architect or E I ress:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing wM Section 7000) of Division 3 of the Business and Professionals
Code, and my Lice r► Is in full force and effect.
License Class License No. (o ZJ
Date ®f Contractor 4-k"W
`
OWNER43UILDER DECLARATION
1 hereby affirm under penalty of perjury that 1 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 Contractofs' Stats License Law (Chapter 9 (commencing with section 7000) of Division 3 of the Business
and Professions ) or.that he or she is exempt therefrom and the basis for the alleged exemption. Any vlolation of Section 7031.5 by any applicant for a pemrit subjects
the applicant to a civil penalty of not more than five hundred dollars (=500).),
U 1, 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 wiltiln 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 ContraCODrs' State License Law.).
U I am exempt under Sec. . B.& PA. for this reason
Date Owner._.
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under 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 performance
of the work for which this permit is issued.
II haveandwill maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
P, ensattoncarrier and mber .
Carrier ` Policy
042 / /Uall
_ 1 certify that, in fire performance of the work for which this permit is issued, l shag not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, If. 1 should became subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
ft rrthwwith comply with those prons. /fin
Date Applicant
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 ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS 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
Lenders 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.
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 shag, defend. Indemnify and hold hamdess 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 pemdt issued as a result of this application becomes null and void If work Is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject perrdt to cancellation.
1 certify that I have read this application and state that the above information is correct 1 agree to
comply with ail city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to upon the above-mentioned property for inspection purposes.
Date Signature (Applicant or Agent):
Application Number . . . . . 04-00004688
Page 2
Date 6/01/04
Qty Unit Charge Per
Extension
1.00 30.0000 EA ELEC
PRIVATE SWIMMING POOL
30.00
-----------------------------7----------------------------------------------
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
--------=----------------------------------
Permit . . . . . . WALL/FENCE
---------------------------------
PERMIT
Additional desc . .
Permit Fee . . . . 15.00
Plan Check Fee
.00
Issue Date . . . .
Valuation
65
Qty Unit Charge Per
Extension
BASE
FEE
15.00
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Special Notes and Comments
POOL & SPA BBQ ANSI Z21-58-1995
6 LF 5' WALL CITY STND. ALARMS BARRIERS
SHALL BE IN PLACE PRIOR TO
PREPLASTER INSPECTION.
Fee summary Charged
-----------------
Paid Credited
Due
--------------------
Permit Fee Total 306.00
--------------------
00 .00
306.00
Plan Check Total 148.35
.00 .00
148.35
Grand Total 454.35
.00 .00
454.35.