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RPL (04-6584)l� 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 . X04-00006584 81235 MUIRFIELD VILLAGE 762-410-0111-- POOL 62-410-011=POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 19000 Owner ------------------------ TOLL CA V C/O KEVIN D DUERMIT 8901 E MOUNTAIN VIEW 200 SCOTTSDALE AZ 85258 Contractor Date 10/01/04 CALIFORNIA POOLS & SPAS P.O. BOX 1280 COACHELLA CA 92236 (760) 398-9222 WCC: STATE FUND WC: 04600061168 01/01/05 CSLB: 656128 10/31/04 CCC: C8-C27-C29=C53 ---------------------------------------------------------------------------- Permit . . . . BLDG POOL PERMIT Additional desc . . Permit Fee 198.00 Plan Check Fee 128.70 Issue Date . . . . Valuation . . . . 18920 Qty Unit Charge Per Extension BASE FEE 45.00 17.00 9.0000 THOU BLDG 2,001-25,000 153.00 --=------------------------------------------------------------------------- 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 ---------7---------------------------------------------------------7-------- 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 Tr t P.O. Box 1504 • 1�� VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-701 1 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Qq- Date: l0•lvr0 i% Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: V 1r7 Lic. No.. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under Bions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Co , n l my Lir�fTse i�imfgp force and effect. cense Classl J 7 � —i3ate/0/6/0C/ ntrp6 acfnr aw, 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 -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). U I, 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 I hereby affirm under penalty of perjury one of the following 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 performance Xof 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 pernit is issu I�f�workers' ompensation in"nce cam r a d lic r re• �� er� F-Gl4 icy Number I certify that, in the performance of the work for whthis pe it is issued, 1 shall not employ any person in any manner so as to become subject to the workers' ' compensation laws of California, and agree that I should ecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those prions. 0, WARNING: FAILURE TO SECURE WOR0tRS' COIv1PE'QA?f6N OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR 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, indemnity and hold harmless the City of La Ouinta, 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 " t commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above n iormation is cor I agree 6 comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this count enter upon he ove-me 'oned property for inspection purposes. ateZ/ / " �nature icant or Agent): Page 2 Application Number . . . . . 04-00006584 Date 10/01/04 Qty Unit Charge Per Extension 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 ---------------------------------------------------------------------------- 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 ---------------------------------------------------------------------------- Permit WALL/FENCE PERMIT Additional desc Permit Fee 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 80 Qty Unit Charge Per Extension BASE FEE ---------------------------------------------------------------------------- 15.00 Special Notes and Comments POOL/SPA, BBQ (ANSI Z21-58-1995), 5 L.F. 4' GARDEN WALL, CITY STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION Fee summary Charged Paid Credited ----------------- Due ------------------------------ Permit Fee Total 315.00 .00 .00 ---------- 315.00 Plan Check Total 154.20 .00 .00 154.20 Grand Total 469.20 .00 .00 469.20