RPL (04-7522)o
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BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
OF1119 78-495 CALLE TAMPICO • yFAX (760) 777-7011 .
LA QUINT, CALIFORNIA 92253 INSPECTLON REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . .04-00007522 Date 12/01/04
Property Address . . . . 56725 MOUNTAIN VIEW
APN: 762-320-006-5 -29147 -
Application description POOL -RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation . 15000
Owner Contractor
INGRID TRINKLE " ALPINE SERVICES
56725 MOUNTAIN VIEW P.O. BOX 4687
LA QUINTA 192253' PALM DESERT -CA 92261
DSC 2 2004
WCC: STATE FUND
WC: 229002323604 '01/01/05.
Y OFlAQ1l1NTk`, CSLB: 786324 10/31/06
CIT
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1:IN
ONCE CCC: C53
--------------- ------------------------
Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Fee 162.00 Plan Check Fee 105.30
Issue Date Valuation 15000
Qty ..Unit Charge Per Extgnsion
BASE FEE `45.00
13.00 9.0000 THOU BLDG`.2,0.01.-25,000 117.:00
--------------------------- -----------`------"------------------------ ---------
Permit MECH POOL
Additional desc
Permit Fee 24.00 Plan Check.Fee 6.0.0
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 s 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
----------------------------------------------------------------------------
Permit . . . . . PLUMBING
Additional desc
Permit Fee 33.00 Plan Check Fee 8.25
P.O. BOC 1504 �&V
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Application Number: OLl - 7 rJ' 01 a Date:
Applicant: I Architect or Engineer:
Applicant's'Mailing Address:
Architect or Engineer's Address:
Lic. No..
tsUILUINU 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 i in full force and effect. .7A 6,3
�icense Class cense No. J 2
/Date O- O2 _C Y /contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License Law for he 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 he 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 he 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 he 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 hereon, 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
of the work for which this permit is issued.
1 have and will maintain workers' compensation insurance, as required by Section 3700 of he Labor Code, for the performance of he work for which this permit is
ssyed. M workers compensation' nce carrier and policy nym re:
arrie, r �/N/) olicy Number 2- f DO L 3 �� y
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 he workers'
compensation laws of Califomia, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
r
ate 2_ pplicant
WARNING: FAILURE TO SECURE KERS' COMPE 10 OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED USAND DOL R ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ORNEY'S FEES.
ING
I hereby affirm under penalty of perjury that there is a construction lending
CONSTRUCTION
agency orJthe performance AGENCY
oC he work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address �(
IMPORTANT Application is hereby made to the Director of Buildingand Safety ACKNOWLEDGEMENT
y 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 becomes null and 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 permit to cancellation.
I 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
/con�str/uction, and here/by authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
Dace ' 2� 0 �`fl% Signature (Applicant or Agent).
Page 2
Application Number 04-00007522
Date 12/01/04
Issue Date . . Valuation
0
Qty Uni.t 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/SPA, BBQ.(UL,# ETL3020914)
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
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