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04-7115 (RPL)53700 Avenida Madero 04-7115 Tdy, _ (® ► 4. BUILDING & SAFETY DEPARTMENT u .•„m -7Box Box 1504: (760),777-7012 OF9 78-495 CALLE TAMPIco r 'FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number, 04-0000.7115 Y _ Date :11/05/04 Property Address y. —53700 AVENIDA` MADERO APN: 774-103-028-15 -000000- Application description POOL - RESIDENTIAL Property Zoning COVE RESIDENTIAL' Application valuation 8000 Owner -- Contractor ------------------------- CORONEL ENT CORONEL'CONSTRUCTION PO, BOX 389 P.O. BOX. 389 LA QULNTA CA 92253 LA QUINTA CA 92247 (760) 564-4604 WCC: STATE FUND WC: 1744453. .01/01/05 CSLB: 634981 01/31/06 CCC.: 137C13 -- - - - - - - - - - Permit . . . . : MECH POOL Additional desc Permit Fee 24.00 Plan Check Fee 6.00 Issue Date . . . Val-uation 0 Expiration Date 11/05/05 Qty Unit Charge Per" Extension. BASE FEE 15.00 1.00 9.0000 EA. MECH. FURNACE.,<=100K 6 9.00 -- - - - - - - - - - - --- - - - - - - = - - - -------------- - - - - ---=-`----`=------------=----=- Permit . . . _ BLDG POOL PERMIT Additional desc . Permit Fee 99.00 Plan Check,_Fee - 64.35 Issue Date. Valuation 8000 Expiration Date 11/05/05 Qty Unit Charge Per Extension BASE FEE 45.00 6.00 9.0000 THOU BLDG 2,001-25,000 54.00 ------------- Permit ELEC POOL PERMIT -RES Additional desc Permit Fee 45.0`0 Plan`.Check Fee 11.25 Issue -Date Valuation 0 Expiration Date 11/05/05 Qty Unit Charge Per. Extension BASE FEE 15.00 1.00 30.0000 EA ELEC,.'•P_RIVATE SWIMMING POOL d 03'•0.00. ---------------------------------'=-----------------=-----=-------=--=------- P.O. BOC 1504 • ,�C�� 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Eng Lic. No.: BUILDING PERMIT DECLARATIONS VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: i 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 Li ense is in full force and effect. 1 License Class -a% rt 53 1 4& s — License No. \ Date-rJ-4, f Contractor ,( OWNER -BUILDER DECLARATION 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 fora 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 WORKERS' COMPENSATION DECLARATION I 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 iss ed. W workers' compensation insurance carrier and policy num re: Carrier Policy Number V-7 '41-A � 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 Califo ia, and agree that, if I sho ecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those visions. Dated _tA� 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 ATTORNEY'S 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 Lender's 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 shall, defend, indemnify 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 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the a e information is corr ct. I agree com y with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this co n to enter pon a ove-me one roperty for inspection purposes. Date ��1. O`-� Signature (Applicant or Agent): Page .2 Application Number 04-000.07115, Date 11/05/04 Permit . . PLUMBING. Additional desc Permit Fee 33.00 Plan Check Fee :. .8.25 Issue Date Valuation 0 Expiration Date 11/05/05 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 INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged Paid Credited Due Permit Fee Total 201.00. .00 .00 201.00 .Plan Check Total 89.85 .00 ..00 89.85 Grand Total 290.85 .00 .00 290..85 1®®® loom loom loom ir.r"I 11 L. 111 fig 1-4 m I NO I NOR, MMMIN ® 0 crTY..'OF LA QUI ode H BUILDING & SAI%W, I Lz: ,in