RPL (04-6387)u�w
BUILDING & SAFETY :DEPARTMENT
w4�rP O. Box .1504 (760).777-7012 .
1 -495 CALLE _TAMP.ICo FAX (760) 777=7011"
QUiNTA, CALIFORNIA .92253,INSPECTION REQUESTS (760) 777-7153
�E� 2 BUILDING: PERMIT
?i
04-0.0-006 Of Lt. ?,
Gp<on Number 04-00006387 Date 9/22/04'
roperty Address,- `1 ��-570-85 MOUNTAIN -VIEW .
APN.: 7627350-012-
Application description* POOL' RESIDENTIAL
Property..Zoning LOW-DENSITY RESIDENTIAL
Application valuation 16000
Owner.: 'Contractor
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CRV GOLF'WEST CALIFORNIA POOLS & SPAS
C/O ALEX ZIKAKISP..0. BOX 1280
92.55 TOWNE CENTER 'DR. 520. .COACHELLA .. CA 9.2236
SAN DIEGO CA .92.121. (760) 398-9222
WCC:STATE. FUND
046000:61168 01/01/05.;'.
CSLB:. 656128 10/31/04
CCC':' C8 -C27 -C29-053-
Permit MECH POOL :
Additional desc 4
Permit. Fee _24.00. Plan. -Check Fee 6.00`
Issue Date Valuation 0°`.
.Qty Unit. Charge ... Pex Extension
BASE • FE& ...
15.00,_
1.0.0 9.000;0 ,EA MECH FURNACE :<=100K 9':00
Permit BLDG POOL PERMIT
Additional desc
Permit .Fee 171-00.Plan :Check' Fee'. 111'.15
Issue. Date Valuation 1600.0
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. 45.00 Plan Check:. Fee -11:25
Issue Date. Valuation 0
Qty Unit Charge' Per Extension
BASE FEE 15.00.
i.
• r
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number.
Applicant:
Applicant's Mailing Address:
BUILDING & SAFETY DEPARTMENT
VOICE (760) 7.77-7012
: FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: . 4 -.1-7 'v
Architect or Engineer -
Architect or Engin AP r s:
Uc. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjurythat I am licensed under provisions of Chapter 9 (oOMMeneing wlih Seddon 7000) of Division 3 of the Business and Professionals
Code, and my Uoens� o in full force and effect.
License Class L-=. 53 Uoense No. 6Z 12
13
Date?/2-74ycontractor
OWNER -BUILDER DECLARATION
1 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: Any
city or county that requires a permit to constnrct, alter. improve, demolish, or repair any structure. prior to ft Issuance, also reWres 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 (comrnencing with Seedon 7000) of Division 3 of the Business
and Picfessions 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 CIA 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 appy 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 imp ovamenffi are not intended or offered for sal& lf, however. the budlding or kMrovement is "
sold within one year of Canpietlon, the owner -builder will have the burden of proving that he or she did not build or Improve for the purpose of sale.).
(,) 1, as owner of the property. am exclusively contracting with licensed contractors to construct the projed (Sec 7044. Business and Professions Code: The Contractors' .
State License Law does not appy to an owner of property who builds or Improves thereon, and who contracts for the projects with a contractor(s) Itcensed pursuant to
the Contracbors' State License Law.).
U 1 am exempt under Seo. . BA PSC. for this reason,
Date Owner..,
WORKERS' COMPENSATION DECLARATION
hereby affirm under penalty of perjury am of the following declarations:
•
_ t have and.wtll matntaln a certificate of consent to self4nsurefor works' Cortpensation, as provided for by Section 3700of 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'Sekxion 3700 of the Labor Code, for the performance of the work for which this permit Is
Caroler P reCan en
• satlon.lnsurance carrier and po��ymber are:
-= Policy Number
I.certify that, In the performance of the work for which this pemmlt ds Issued. -I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if. 1 should became subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shah
forthwith comply with those provftAns.
Date2 o
Appfican
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), ;N.ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury t6it there is a construction lending agency for the performance of the work for which this permit Is Issued (Seo- 3097, Civ. C.).
Lender's 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 Misapplication Is made, each person at whose request and for whose benefit work is perfomned under or pursuant to any permit
Issued as a result of this application, the owner, and the applicant, each d shall, defend, Indemnify and told hamnleas the City of Le tlulnta, Its
officers, agents and employees for any act or omission related to the ' tmeing pert under or following issuance of this permit.
2 . Any permit issued as a result of this application becomes null and void Is not ced wiWn.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 t to oompty with all City and county ordinances and state taws relating to building
construction, an
yd hereby authorize representatives of this Doan enter upon a Honed property for inspection purposes
Date 7 /� Signature (Applicant or Agent):
i S
h
Page • 2
Application Number . . . . 04-00006387
Date 9/22./04
,Qty Unit Charge Per
Extension
1.00 3'.0-.0000 EA ELEC PRIVATE SWIMMING
POOL
30.00:
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Permit PLUMBING
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Additional desc
Permit Fee 33.00 Plan Check'
Fee
'.' 8.25
. Issue Date Valuation
.''0
Qty Unit Charge Per
Extension.'
BASE .FEE
�. i.'5;,.: 0 0
2.00 6:0000 EA PLB FIXTURE
1.00 3.0000 EA PLB WATER INST/ALT/REP
1.1,00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS-
, ..:
3.00.
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Special Notes.and Comments
POOL & SPA', ONLY. FIREPIT 496 AGAL.
ALARMS'BARRIERS SHALL BE IN PLACE PRIOR
. TO PREPLASTER INSPECTION. EQUIPMENT
ENCLOSURE NOT•INCLUDED:IN'•PERMIT. `
Fee summary Charged Paid Credited
Due
Permit Fee Total 273.00 .00
.00
273..00
Plan Che:ck'Total 136.65 .00
.00
136'.65
Grand Total- 409.65 .00
.00
409.65
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