RPL (04-6640)53201 Avenida Martinez
04-6640
t G1 GJ
BUILDING .& SAFETY DEPARTMENT
P.O.. BOX 1504 (760).777-70.12
78-495 CALLS TAMP.ICO FAX (760) 777=701.1
LA QUINTA, CALIFORNIA .92253 INSPECTION REQUESTS (760) 777-7153
BUILDING. PERMIT
Application Number
04-00006640 Date
10/06/04
Property .Addres_ s-..
53201 AVENIDA MARTINEZ.
.-APN:
774-061-022-10 -000000-
Applica.tion.description..
POOL = RESIDENTIAL
-
Property Zoning
COVE RESIDENTIAL.
Application valuation..:
1.3000
Owner.
Contractor
----.------.--------------
--------=_---
HERN JOSEPH A.
CALIFORNIA"POOLS & SPAS
53201 AVENIDA MARTINEZ
P.O. BOK 1280
LA QUINTA CA 92.253"
COACHELLA CA
9223'6
(760) 398
WCC: - STATE .FUND :
WC:. 04600061168
01/01/05
CSLB: 65612.8
1:0/31/04
CCC:.. C8. -C27 -C29-05.3
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. 7 9.0.0.00 EA
MECH.FURNACE <=100K
9.00
Permit.. BLDG
POOL. .PERMIT
Additional'desc
Permit 'Fee 144.00
Plan Check. Fee
93..60.
Issue Date
Valuation'
13000
-Qty Uriit Charge Per
Extension
BASE FEE
45.00
11...00 9.0000 THOU
-------------------
BLDG 2,0.01-25,000
99.00
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
78.495 CALLS TAMilCO
LA QUINTA, CALIFORNIA 92253.'.
Application Number.
Applicant:
Applicant's Mailing Addeess:
BUILDING & SAFETY DEPARTMENT
VOICE (7 66) 7.77-7012
:FAX (760) 777-7011
INSPECTIONS (760) 777-7153-
BUILDING
77-7153
Date:
Architect or Engineer.
Architect or Engineer's Address:
Uc. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Sodom 7000) of Division 3 of the Business and Protessbnals
Code, and my t:bens b in full rave and effect..
License
I Class LJcense No. &Z, 12 S
oaten d 0 C«�or `
I hereby affirm under penalty ofperjury filet I am 01,NNER-BUILDER DECLARATION
exempt from the ContrarioW State P.ioense Law for the knowing reason (Sec. 7031.5. Business -and Professlons Code: Any
dty or county that MOM a Pelt b =+afnlct, altar. improve. demolish, or.repair any structure. Prior to ks hwance, also requires the applicant for fie. permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contrgclore State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Piotessions Cope) oulliat he Of 8110 Is exempt therefrom and the beds for the alleged exemp lim Any vtotation of Section T031.5 by any applicant for a permit subjects
the applicant to a civilpenalty of not mora than fire hundred dollars ($500).r
U I. as owner of the Property, or my employees with wages as their sole •
Business and Professions Code: The Contractors' State License � �' wy do the wok, f pi pe ty who b it not intended t offered for sale (Sea 7044.
apply b an owner of property who builds a improves thereon, and who does the work
himself qr herself or through his «her own employees, provided -that the (mprovements,are not intended or oNered for safe. If. however the bull trq 9rkmprovembntis
sold within one year of completion, the owner -builder will have. to burden of proving that he or she did not bund or improve for the purpose of sale.).
U 1. as owner of the property. am exclusively contracting with icansed contractors Io construct oe project (Sec. 7044. Business and Professions Code: The Cw*adoW .
State License Law does not appy to an owner of property who builds or Impmves thereon, and who contracts for the projects with a eontractw(s) licensed pursuant to
the Contractors` State License Law.).
L) 1 am exempt under Sea . B.& PSC. for this mason,
Date . Ownerj
WORKER$' COMPENSATION DECLARATION .
1 hereby affirm under Penalty of PerjaY one of the following declarations:.
_ 1 have and.wil maintain a certificate of consent to selfansure for workeW compensation, as provided for by Sodom 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'Secdon 3700 of to Labor Code. for the pedonnance of the work for which tins permit is
�1ywedMy vro rs' Dom ensation.insurance carrier and poi'iram,
carrier,.i-P , Policy Number 05/(o/)/YM l//lei
_ 1. verify that, In the performance of the work for which Renis pemmltls issued. I shall not employ any person In any manner so as to beooma subject to the workers'
compensation laws of California, and agmme that. if I should become wbiect to the waken' compensation PwAsions of Section 3700 of the Labor Code, I shad
forthwith comply with those
Date /� Applicant
WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS, UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CiVIL FINES LIP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). INADDiTiON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR 1N
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that them Is a construction lending agency for Re performance of the work for which this permit Is Issued (Sea 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 appicatlai.
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 told hamiless the City of La Quit". its
officers, agents and employees for any act or omission related to the. Wilk being perfomed under or. following Issuance of this pemML
2 Any permit issued as a insult of this application becomes nun and void If b commrmmenced wltfmin.180 days from date of Issuance of such pemat, or
cessation of work for 180 days evil Subjectpermit to cancellatton.
1 certify that I have read this application and state that the above Information Is I comply with an city and county ordinances and state laws relating to building
constriction, and reby authorize representatives of this county to orupon tioned property for Inspection purposes.
.a _ Signature(Applicant or Agenl):
Page 2
Application Number . . . . . 04-00006640 Date 10/06/04
----------------------------------------------------=----------------------=
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 ONLY. ALARMS BARRIERS SHALL BE IN
PLACE PRIOR TO PREPLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED IN
PERMIT.
Fee summary Charged
Permit Fee Total 246.00
Plan Check Total 119.10
Grand Total 365.10
Paid Credited Due
.00 .00 246.00
.00 .00 119.10
.00 .00 365.10
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