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RPL (04-5395)54385 Avenida Madero 04-5395 0'9 2004 ot 14 CITY Df-LAQl III TA BUILDING & SAFETY DEPARTMENT P_:°O!'"Bo°z 1-504 (760).777-7012 OFT19 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number 04_7.00.005395 Date 7/09/•04 Property Address . . . . . . 54385 AVENIDA MADERO APN: .774-231-016-5 000000 - Application description POOL - RESIDENTIAL Property Zoning . . . . . . . COVE RESIDENTIAL Application valuation.. 16000 Owner Contractor ------------------------ -------- -'---------- EVANS PAULDEN EVANS DESIGN INC, PAULDEN 4886 PALO VERDE LN P.O. BOX 621 RIVERSIDE. CA 92501 RIVERSIDE CA 92502 (909) 788-6780 WCC: STATE FUND WC: 76837803 08/15/04 CSLB: 652188 .08/31/04 CCC: B . ----------------------------------- 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 BLDG POOL PERMIT' Additional desc Permit Fee 171.00 Plan Check Fee 11-1.15 Issue Date Valuation. 16000 Qty Unit Charge Per Extension BASE FEE 45.00 14.00 9.0000 THOU BLDG 2,001-25,000 126.00 Permit . . . . . . ELEC POOL PERMIT -RES Additional desc Permit Fee . . . . 15.00 Plan Check Fee 3.75 .Issue Date Valuation 1 . Qty Unit Charge Per Extension BASE FEE 15.00 P.O. BOX 1504-- • 44" VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QutNTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 3 Date: 9 B So Applicant:/` Architect or En ineer: O/' Applicant's Mailing Address: Architect or ngineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licens under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Licencevis in full force and effe / Q License Ch / / I ' ncp Nn Date cf_b y OWNER43UILDER DECLARATION I hereby affirm under penalty of perjury that I am exe t 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).): 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 1, 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 Owner WORKERS' COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self4nsure 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. o 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 issued. My work ' compe nrmsation insurance card er and policy number are: Carrier ,43- d'_Policy Number Z R 3:2 Qe) :5 _ 1 certify that, in the performance of the work for whichthispermm —is Issued. I sha not employ any person In any manner so as to become subject to the workers' compensation laws of California a that, ishould become sub' the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those p sions. Date . 0 y Applicant WARNING: FAILURE TO SECURE WORKERS' COMPEIAT1"N 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 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 can a on. 1 certify that I have read this application and state that the above i ormation is co ect. I agree to comply with all . nd county ordinances and state laws relating to bui ng construction, and hereby authorize. representatives of this county o enter upo red propert inspection purposes. Date - t Y Signature (Applicant or Agent): Page 2 Application Number . . . . . 04-00005395 Date 7/09/04 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 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special. Notes and Comments POOL/SPA. PERMIT DOES NOT INCLUDE WALLS.BARRIERS AND ALARMS TO BE IN PLACE PRIOR TO PREPLASTER INSPECTION. Fee summary Charged Paid Credited Due ------------------------------------------------------ ---- Permit Fee Total 243.00 .00 .00 243.00 Plan.Check Total 129.15 .00 .00 ,129.15 Grand Total 372.15 .00 .00 372.15