Loading...
RPL (04-6467)52701 Avenida Martinez 04-6467 w Tihf °F wQ rw P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT Application Number . . . . . Property Address . . . . . . APN:' Application description . . . Property Zoning . . . . . . . Application valuation . . . . BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 04-00006467 Date 9/29/,04 52701 AVENIDA MARTINEZ 773-301-022-9 -000000- POOL - RESIDENTIAL COVE RESIDENTIAL .9000 OwnerContracto BAUMANN RAY OWNER 52701 AVENIDA MARTINEZ LA QUINTA CA 92253 r ' CITY OF LA QUINTA FINANCE DIRPT Permit MECH POOL Additional desc Permit Fee 24.00 Plan Check Fee 6.00 Issue Date Valuation 0 Expiration Date 3/28/05 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 . . . . 108.00 Plan Check Fee 70.20 Issue Date Valuation . . . . 9000 Expiration Date 3/28/05 . Qty Unit Charge Per Extension BASE FEE 45.00 7.00 9.0000 ---------i----------------------------------- THOU BLDG 2,001-25,000 63.00 Permit . . . . . -------------------------------- ELEC POOL PERMIT -RES Additional desc Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date Valuation . . . . 0 Expiration Date 3/28/05 .Qty Unit Charge Per Extension BASE FEE 15.00 _11.00 30.0000 --------- ---------------'-------- EA ELEC ------------- PRIVATE SWIMMING POOL ------------------------------ 30.00 a 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: Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS 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 License is in full force*and effect. License Class License No. Date 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 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. build ill 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 ontracting wt licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of pr erty wO 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. B.& P. , for is reaso Date 1 D Owner l WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjuryone of the fol wing 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 perfornance 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 issued. My workers' compensation insurance carrier and policy number are: Came 'cy Number I certify that, in the performance g hew k for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensationlaws of Califomia, and gree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisio Date V / gpplica WARNING: FAILURE TO SECURE WORKERS',dOMPENSATION 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 Safetv 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 becomesulf a T void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 160 days will subject permit to cancella n. I certify that I have read this application and state that the above i6fo anon is co ec . I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this count t nter upon ove mentioned property for inspection purposes. Date / , /r U Signature (Applicant or Agent)/ �/ Application Number . . . . . Permit PLUMBING Additional desc Permit Fee . . . . 33.00 Issue Date . . Expiration Date . . 3/28/05 04-00006467 Plan Check Fee Valuation Page 2 Date . 9/29/04 8.25 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 . . . . 81.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 5732 Expiration Date 3/28/05 ;Qty Unit Charge Per Extension BASE FEE 45.00 4.00 9.0000 THOU BLDG 2,001-25,000 ------------------------------------------------------------------- 36.00 7 Special Notes and Comments POOL/SPA, 80 L.F. 5' GARDEN WALL, CITY STANDARD ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. 160;1n. ft. SIX FT. BLOCK PER CITY STAND. 9/29/04 8:53:02 AM jjohnson Fee,summary Charged Paid Credited ---------------------------- Due ------------------------------ Permit Fee Total 291.00 .00 .00 291.00 Plan Check Total- 95.70 .00 00 95.70 Grand Total 386.70 .00 .00 386.70 Cl -Pt OF LA SUiLDING. & SAFETY jl 777. ANOPPC;"! Ecz FOR CONG'l RUCTION DATE q -'27-0t-- ! f t 7 Mlr WpI„v )q CITY OF LA QUINTA SUB -CONTRACTOR LIST .= PERMIT.NUMBER j OWNER BUILDER JOB.ADDRESS 7ol 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 are authorized to work in stoppage of work and/or the voidance on.this job. Any changes to this list must be approved.by the Building Division prior to commencement of work. Failure to comply will result a • trade, all:information requested bellow must be completed by applicant. "On File" is not an acceptable response. each applicable t a 4 0 f building ermit.. For pp P. .. ................. ...........::..................:.::..:.:............................ ::::..::.......::::.:.::::::::::::: »>:::Trade:::i>;C.lassificatior :::>::>::>:::>::» .............. :;:;:.::.;:;;:.;:.;:.;:.>:.>:.;:<ca ........... :.::.::.......................::::::.::::::::::.:::::::::.:::::::...:...:. rtitractor.;:.;;:;:.;:;;:.::.;::<;::.::::;::;:.;.;:.;:.;:.;:.:<.;:.:.;:.;;:;.;:.;:.;::State.;:C.ontratbr.:s.:4....:............................ ...:.:........................................ :::.::.:::::::::.:::. ehse.::;:>::>::>::;;::.;:::::::::;.;;:.;:.;:.;:.;:.;:.;:.;::;:.:;:;.;:::;.;:.:<.;:.;:.;:.;:.:;.;.:.:.................................. > < tion:::Ir15Urance::;;;:.;::::e>::>:;:.;:.::.;: ;:.;:.;:.;:.:::::::::::.::::::::::................... Workecs..Com ansa...:.................................. _ an N ame Company Com Classification ion se Number er License 1 Exp. . Date E P :x xx x / x/ 1 Carr ier Name Cal Com e. State Fund, 1 1 9 P Polic N umber Exp. Date Y x x x xx / ) Varies)l x/ F rmat 1 (Format License Number x xx 1 x ) Exp. Date xx xx xx / / 1 RT MOR.— 2):<>; : O Q,ES - (e.g. B C8 9 l xx xxx x . e I J vs o 17 3 3 -o oQ— .... '%1:'L C. D 3 S S e U N oa 7 1-o S' 2 i . 67171-51-0 3 s s yte G 53 a 1 3 3 r A- L als S t e I [ "• o a -o 6 zs Z b Y Z to L L - 1-0 .00 Lf G 3.31-9 . 3392. - >C` F1fGTILT4,C:::5:.;.<1.>:.:::.:;;:<. L v L / 2 u o B y S 5 _ 3 c s TS;1..... :::-;;;..::::::.... c 5 3 3 I T _ b X01"