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RPL (04-5275)TWr �F�Q�rw 504 .LE TAMPICO CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . .. . 04-0.0005275 Date 6/30•/04 Property Address .. . . . ... 53925 AVENIDA MENDOZA APN: 774-172-019-9 -000000- Applicatiori description POOL - RESIDENTIAL Property Zoning COVE RESIDENTIAL Application":valuation 15000 Owner Contractor HANRON CORP AJF CONSTRUCTION. P.O; BOX 4019 P.O. BOX 5..77.24. . PALM.:DESERT. CA 922.11 SHERMAN OAKS CA 9141,3 760).64.1- 5988 STATE. FUND. WC.:.' 13711632003 10/01/04 . CSLB: 787537.. .11/03/04 CCC: :.. B. Permit BLDG POOL PERMIT Additional desc Permit Fee 162.00 Plan Check Fee 1`05.30 Issue Date Valuation 15000 Qty Unit . Charge Per. -Externsion BASE FEE 45.00 13.00 9:0000 THOU BLDG 2.,.001-25,0.00 117.00 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 . . . . . . 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 495 • 'GC�� 78 - CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT 1 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: Date: Applicant: I Architect or Engineer: Applicant's Address: 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 8 (commencing with Section 7000) of Division 3 of the Business and.. Professionals and my License is.in full force and effect LIoense CIasS rcense No. ate contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License law for the fogovdng 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 (comnendng 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 1, 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 ,himseff or herself or through his or her own employees, Provided that the improvements are not intended or offered for sate. If, however, the building or improvement Is sold In one year of completion, the owner builder will have the burden of proving that he or she cid not build w kriprove for the purpose of saleJ. I, as owf thepStatense Law does not.app owner of property who Guilds or improves thereon,. and who contracts torr the projects with a contrador(s) lx�ensed pursuant to the Contractors' State License ). () I am exempt under Sec. B. Cfor this reason Date, (430 0 o� WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: , _ 1 have and will maintain a certificate of consent to selfminsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance the work for which this permit is issued, I have and will. maintain workers' compensati n 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 nae carrier and policy number are: /mer olicy Number certify that, in the performs 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 afifomla,, a agree that, If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with runs. , -3%14 WARNING: FAILURE TO SECURE WORKERS' 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.). Lenders 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 application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is perfomred under or pursuant to any permit Issued as a result of this application, the own a ap t, each agrees to, and shall, defend, indemnify and hold hannle.ss the City of La Cuinta, its officers, agents and employees for any ad omission related to work being performed under or following issuance of this permit 2. Any permit issued as a result of this appli 'on becomes null an 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 ermit to can. llati I certify that I have read this application and state that above info on is coned. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize. representatives of 's county upon the abov . tinned roperty for inspection purposes. 6a e �O Signature (Applicant or Agent �y Page 2 Application Number . . . . . 04=00005275 Date 6/30/04 ---------------------------------------------------------------------------- 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 ----------------------------------------------------7----------------------- 3.00 Special Notes and Comments POOL/SPA. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED - Fee summary Charged Paid. Credited ----------------- Due ------------------------------ Permit Fee Total 264.00 .00 .00 ---------- 264.00 Plan Check Total 130.80 .00 .00 130.80 Grand Total 394.80 .00 .00 394.80 BUI, St I:r--P( DEPI ` t . • , ; OJI16-iflue ri N BY DATE 4 -MOW MR. • Ow Flo. jQ br Au IL 1. LAOPAEi ®OX 18¢8 J LM%CA SM Amum? t I Arm P. 14 POOL Z' :zs PAW. klewe HIGH X" VIALL .16 It A= 3Nn M A"N.- t if ')4 5 5.025 kv mEt ) k 0 aia . — •- ;- C