RPL (04-4028)54324 Avenida Madero
04-4028
0
BUILDING & SAFETY DEPARTMENT
0. Box 1504 (760),777-7012
8-495 CALLE TAMPICO FAX (760) 777-7011
p 112004 A QUINTA, CALIFORNIA -'9,2253 INSPECTION REQUESTS (760) 777-7153
or. LA %M'yj'A BUILDING PERMIT
e 1:04 Ce OEM.
Application.Number . . . . . 04-00004028 Date 5/10/04
Property Address 5432.4 AVENIDA MADERO
APN: 774-232-003-21 -000000-
Application description . . . POOL - RESIDENTIAL
Property Zoning . . . . . . . COVE RESIDENTIAL
Application valuation . . . . 21000
Owner Contractor
------------------------ ------------------------
EKHOLM DENNIS M CAIPO, GUILLERMO W.
54324 AVENIDA MADERO 38077 CROCUS LANE
LA QUINTA CA 92253 PALM DESERT CA 92211
(760) 200-1000
WCC: EXEMPT
WC: EXEMPT 07/11/04
CSLB: 816693 01/31/05
CCC: B
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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
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Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Fee . . . 216.00 Plan Check Fee 140.40
Issue Date . . . . Valuation . . . . 21000
Qty Unit Charge Per Extension
BASE FEE 45.00
19.00 9.0000 THOU BLDG 2,001-25,000 171..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
P.O. Box 1504 • VOICE (760)'777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Date: 5
Architect or Enineer:
C L_'f 7
Ardhite6t or Engineer's Address:
Lic. No.: 33!mcp
BUILDI G PERMIT DECLARATIONS
LIC ED CONTRACTOR'S DECLARATION
affirm I hereby arm under penalty of perjury that I am licensed 9 22
cans of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Lice a is' f II force and effect.
License Class
Date --d
!G 41 Contractor
OVF ors. ILOER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Cont j tors"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, demolis , 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).):
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, p vided 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 wi ave 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 ' licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of p 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 u der Sec. BA P . fo this as h
Date " Owner
Lhereby affirm under penalty of perjury one of the followrtt!
_ I have and will maintain a certificate of cops
of the work for which this permit is issued.
I have and will maintain workers' compensation insc
issued. My workers' compensation insurance cai
Cartier Policy Number
I certify that, in the performance of the work for whiS
compensation laws of California, and Agrft tha ,
forth comply with those provisi s.
Date' 10' f<< air Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENS
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR
SECTION 3706 OF THE LABOR CODE, INTEREST, AND N
COMPENSATION DECLARATION
e for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
J policy number are:
nit is issued, I shall not employ any person In any manner so as to become subject to the workers'
become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
=RAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
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 its made, each person at whos 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 ag s 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 wo in to
under or following issuance of this permit
2. Any permit issued as a result of this application becomes null and void' w rk is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above info on i rr I gree to comply with all city and county ordinances and state laws relating t0 building
constructio , and ereby authorize representatives of this county to ter u n bove-mentioned property for inspection purposes.
Date Cl d Signature (Applicant or Agent):
Fee summary Charged
-- - - - - - - - - - - - - - ------ - - - - - -
Permit Fee Total 395.00
Plan Check Total 179.40
Grand Total 574.40
Paid Credited Due
---------- ---------- ----------
.00 .00 395.00
.00 .00 179.40
.00 .00 574.40
Page
2
Application Number .
. . . . 04-••00004028 Date
5/10/04
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Permit . . . . . .
---------------------------------------
PLUMBING
-----------
Additional desc
Permit Fee . . . .
87.00 Plan Check Fee
21.75
Tssue Date . . . .
Valuation . . . .
0
Qty Unit Charge
Per
Extension'
BASE FEE
15.00
2.00 6.0000
EA PLB FIXTURE
12.00
10.00 3.0000
EA PLB WATER INST/ALT/REP
30.00
10.00 3.0000
------------------------------------------------
EA PLB GAS PIPE 1-4 OUTLETS
30.00
Permit. . . . . ...
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WALL/FENCE PERMIT
Additional desc
Permit Fee . . . .
23.00 Plan Check Fee
.00
Issue Date
Valuation
866
Qty Unit Charge
Per
Extension
BASE FEE
15.00
4.00 2.0000
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HND BLDG 501-2,000
8.00
Special Notes and Comments
POOL & SPA. 40 LF 5'
BLOCK WALL CITY
STND. ALARMS BARRIERS
SHALL.BE IN PLACE
PRIOR TO PREPLASTER INSPECTION.
Fee summary Charged
-- - - - - - - - - - - - - - ------ - - - - - -
Permit Fee Total 395.00
Plan Check Total 179.40
Grand Total 574.40
Paid Credited Due
---------- ---------- ----------
.00 .00 395.00
.00 .00 179.40
.00 .00 574.40
A RE -INSPECTION FEE OF $ ,
WILL BE CHARGED IF THE APPROVED
PLANS AND 10B CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
NO EXCEPj Q*'WAY
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38077 Crocus Lane, Palm Desert CA PROPOSED POOL AND SPA:
N_- 92211 Phone/Fax: (760) 200-1000
' II Cel: (760) 578-6713 Angela & Dennis Ekholm
G►,»a W .O E-mail: williamcaipo@aol.com 54324 Avenida Madera, La Quinta CA 92253 Phone: (760) 408-4991
GENERAL CONTRACTOR LICENSE: BM16M
POOL CONTRACTOR LICENSE: C53 9816693
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CITY OF LA QUINTA SUB -CONTRACTOR LIST
DKA
PERMIT NUMBER 01 —fO:M OWNER W T_* BUILDER_' CjU*%L,1-1Mi_n
r1"Qb_
OB*ADDRESSW
.This form shall be posted on the job with the Building
Inspection Card at all times in a conspicuous place. Only -persons appearing on this list or their` employees
- O'
are authorized
to work
- the Building Division prior to commencement of work. Failure to comply will result in a'stoppage of
on this job. Any changes to this list must be approved by
work and/or the
voidance
,of building.permit. - For each applicable trade, all information requested below must be completed by
applicant. "On File" is not an acceptable.respolise.
........... ...... .......
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Company Name
Classification
(e.g. A, 8, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
C arner Name
.(e.g, State Fund, CalComp)
lo,
Policy, Number
Wormat Varie s)
Exp. Da te
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
. ... .. ...... . ..
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