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BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS .(760) 777-7153
BUILDING PERMIT
Application Number
Property Address
APN:-'
Application description
Property Zoning
Application Valuation
04-0.00052.0-5�� Date
536 04 AVENIDA MENDOZA
774-133-025-19 -000000-
POOL RESIDENTIAL
COVE RESIDENTIAL .
_ 12.000
6/30•/04
Owner Contractor
=' -- - - - - - - - - - - - - - -- -- -= ------._.--------=-------
'BURR CHRISTOPHER S VALLEY POOL &'SPA
* NO.T ON FILE..'.4'7 41 . C. E. ...PALM CANYON;. DR, # 116
UNKNOWN :.-.. CA 999.9.. PALM..SPRINGS CA .92.264
.
3929 ) 778.
WCC:' -..EXEMPT'
1
WC:'. EXEMPT.....: 06/30/05
3O ZOQ4. CSLB:. 721005. .04/30/06
`�►��CCC:: C53
-----.__---=---..---..---�c. =-
---------------------
---------------
PermitPOOL PERMIT
Additional desc�.
Permit Fee .. 135...00 Plan Check Fee .87.75
Issue Date Valuation 12000.
Qty. Unit Charge. Per : Extension,
BASE FEE .45.00
;10.00 9.0000 THOU BLDG 2,001-25,000 90._00
Permit ELEC POOL PERMIT -RES
Additional'desc
Permit Fee 45.00 Plan Check Fee.
Issue Date Valuation 0
Qty Unit Charge Per.. Extension
BASE FEE 15.00
1.00. 30.0000 EA ELEC PRIVATE SWLMMING POOL 3.0:00
Permit . . . PLUMBING
Additional desc
Permit Fee . . . . 27.00 Plan Check Fee:... 6..75
..Issue Date Valuation 0
Qty Unite Charge Per Extension
BASE FEE 15.00
1,00 6.0000 EA. PLB FIXTURE. 6.00
P.O. BOX 1504AL- • '�G��
78-495 CLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
VOICE(760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: (o �10 • O
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencin
Code, and my Lice full force and effect
g with Section 7000) of Division 3 of the Business and.•Professionals
se '
,-CI"oense Class
rDa �O Vitra
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: An
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 pemdt subjects
the applicant to a civil penalty of not more than five hundred dollars. ($500).):
U I, as owner of the property, or my employees with wages es their sole compensation, will do the work, and the structure Is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon. and who does the work
himself or herself or through his or tier own employees, provided that the improvements are not Intended or offered for sale. If, however, the building or Improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U 1. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Conti -actors'
State License Law does not.apply to an owner of property who builds or improves thereon,and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. B.3 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: .
_ I have and will maintain a certificate of consent to selfinsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the,pertommance
of the work for which this permit is issued.
_ I have and will, maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Issued. My workers' compensation insurancecarrier and policy number are:
Carrier Policy Number
I certify that, In the performance of the work for which this permit is issued. I shall not employ any person In any.manner so as to become subject to the workers'
compensation laws of California,. andg�$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 proyWns!
WARNING: FAILURE TO SECURE V(AKERS' 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 ti)e work being performed under or following issuance of this permit
2. Any permit issued as a result of this application becomes null and void Ifwork 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.
1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize. representatives of this county to a upon the a tioned property for inspection purposes.
,,--batmL/ 0 Signature (Applicant or Agent):
-Page 2
Application Number .. . . . .
04-00005205
Date 6/30/04
Qty. Unit Charge Per
Extension
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. -ALARMS/BARRIERS SHALL BE
IN PLACE
AT PRE -PLASTER INSPECTION. EQUIPMENT'
ENCLOSURE -NOT INCLUDED
Fee summary Charged
-----------------
Paid
Credited
Due
----------
Permit Fee Total 207.00
--------------------
:00
.00
----------
207.'00
Plan Check Total 98.25
.00
.00
98.25
Grand Total 305.25
.00
.00
305.25
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\VALLEY POOL &SPA
1 DESIGN & CONSTRUC1ION
�J 4741C E, Palm CanYOn, Ste 116
`. Palma Springs, Ca. 92264
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CITY OF LA OUINITA SUB -CONTRACTOR LIST
m?B ADDRESall S 53640 Ave Mendoza PERMIT NUMBER OWNER, Chris Burr BUILDERyALL£YPaOL&SPA
Js form shbe ookfdon tbLja yvilh the BOILS= Insneefion Card at all timis i`a con3r11sgous Qlaoe. Only persons appearing an'this list or their employees are authorized to work
�
, this job. Any changes to this fist must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
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building ermit. For each ape icable trade all information requested below must be com feted by applicant. `On File" is not an acceptable response.
Trade I Classftstlon 7 Contractor contraotbr s License 1ROtltera erlsaticu Ltsuranoe
EARTHWORK IC -121
FRAMING [C-51
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STRUCT. STEEL (C•61)
NMASONRY IC -291
m .yLUMB)NG IC -361
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DRYWALL (C•9)
7 HVAC IC -201
W ELEcTfAcAL (C-10)
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2: ROOFING IC -39)
SHEET METAL (0.431
FLOORING IC -16)
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FROM
PHONE NO. 7607725860, Jun. 28`2004 03:41AM P2"
City -off La Q.t1inta
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