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RPL (04-6155)I 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 . . Owner ------------------------ ASHBROOK 56885.MOUNTAIN VIEW LA QUINTA CA 92253 04 -000061554 5-6-885 MOUNTAIN VIEW 762-320-014-13 -29 POOL - RESIDENTIAL( LOW DENSITY RESIDE 16000 47 - Date X9/03/04 Contractori. CALIFORNIA O P.O. BOX 1280 COACHELLA (7.60) 398-9222 CA 92236 WCC: STATE FUND - WC: 04600061168 01/01/05 CSLB: 656128 10/31/04 CCC: C8 -C27 -C29-053 --------------------------------------------------------------- .Permit . . . . ... MECH POOL -------------- Additional desc Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 9/03/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00• 9.0.000 EA., MECH FURNACE <=100K 9.00 ---------------------------------------------------------------------------- Permit . . . . . BLDG POOL PERMIT Additional desc-'. a Permit Fee . . . . 171.00 Plan Check Fee 111.15 Issue Date . . . . Valuation 16000 Expiration Date 9/03/05 Qty Unit Charge Per Extension - BASE FEE 45.00 14.00 9.0000 THOU BLDG 2,001-25,000 126.00 Permit . . . . . . ELEC POOL PERMIT -RES Additional desc Permit Fee . . . 4,5:00 Plan Check Fee : 11.25 Issue• -,Date Valuation 0. Expiration Date 9/03/05 P.O. BOX 1504 • / VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: — / Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Eng Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed and ovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Licg�lseys+ ull force and effect. // // / �/ License Class (,� rise (�SC� / Q�Q' Date ?1715 Contractor y OWNER43UILDER 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 1, 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 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. I have rid will maintai orkers' compensation insurance, as required by Section 3709 of the Labor Code, for the performance of the work for which this permit is iss d�.My worke compensation insurance carrier of gVbey'aCarrier ,0 PolJfor I certify t at, in the performance of the wh is pe ued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and f I should be me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall fortthhwith comply with those pro ' ionDate G " Applicant WARNING: FAILURE TO SECURE WOP)&RS' 6000 ENSk`R6I'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 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 ork 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 1 have read this application and state that the above information is ect. I ree to comply with all city and county ordinances and state laws relating to building construction, nd hereby authorize representatives of this cou to nter upo th bo -mentioned property for inspection purposes. Dte a i L 4: Signature (Applicant or Agen l - Page" 2 Application Number 04-00006155'. Date 9/03/04 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 Issue Date Valuation 0 Expiration Date'. 9/03/05 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 3.0,000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 -----=:----=-----:--;------ =------ -'--------- ---------------------- -----------•- Special Notes and Comments POOL & SPA..BBQ-ANSI Z21-58-1995 SHELL. .ALARMS'BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION.' -EQUIPMENT ENCLOSURK NOT INCLUDED IN•PERMIT. Fee summary. Charged Paid Credited Due Permit Fee Total 273.00 .00 .00'' 273.00' Plan Check'Total 13*6.65 00 .00 136.65 Grand -Total 409.65 .'`00- .00. 409.65