04-4706 (RPL)A
T44f 4 4 a"
BUILDING & SAFETY DEPARTMENT
-O. B , 1504 (760).777-7012
78-49 LLE TAMPICO FAX (760)-777-7011
2094Q A,' -CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT .
Application Number . . . .
Property Address . . .
APN:
Application description
Property Zoning.. . . . . .
Application valuation . . .
0.4=.00-_04-7-06-' Date 6/02/04
78535 NAPLES DR
.609-553-008-18 -28458 -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
16000
Owner Contractor
------------------------ ------------------------
SEFTON CALIFORNIA POOLS & SPAS`
78535 NAPLES DR P.O. BOX 1280
LA QUINTA CA 92253 COACHELLA CA 92236
(760) 398-9222
WCC: STATE FUND
WC: 04600061168 01/01/05
CSLB:• 656128 10/31/04
CCC: C8 -C27 -C29-053
--------------------------------------- ------------------------- 7 -------------
Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Fee. 171.00 Plan Check Fee 111.15
Issue Date Valuation . . . . 16000
Qty Unit Charge Per Extension
BASE FEE 45.00
14.00 9.0000 THOU BLDG 2,001-25,000 126.00
----------------------------------------------------------------------------
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 1-5.00,
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
P.O. BOX 1504.
78-495 CALLE TAMPICO w VOICE (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Date:
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
N /iT
Lic. No.:
BUILDING PERMIT DECLARATIONS
I hereby affirm under penaltyof perjury LICENSED CONTRACTOR'S DECLARATION
once that I am licensed under provisions of Cha tpr 9 co+�eencing with Section 7000) of Division 3 of the Business and Professionals
Code, and ss License is in full force and effect. I
�Cicense Class rcense No.(Q G
I hereby affirm under penaltyof vwNER-BUILDER DECLARATION
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 or a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
(-.) I, as owner of the property, or my employees with wages as their sole compensation, wilj 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. It. 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 buildor improve or 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 or by Section 3700 of the Labor Code, or the performance
of 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 or which this
��..i�s u d. M wo�rscompensations in.. carrier a nu are•. y pemtit is
Cartier �riL .l }�-r,�/ri iPolicy Number _ �u�� f7� ELL —6 (1
_ 1 Rity that, in the performance of the wo for which this pertmt is issued, I shall not employ an
compensation laws of California. an P Y Y Person in any manner so as to become subject to the workers'
g e that, it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisio s. _ ,
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.
ENCY
I hereby arm under penalty of perjury that there is a construction lending o
g agency CONSTRUCTION
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 Buildingand Safe for a
1. .Each H permit subject to the conditions and restrictions set forth on this application.
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 Write. 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 pemr8, or
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this applicatiori and state that the ve information is correct. I agree to comply with all city and county ordinances and state laws retatin to building
construction, and hereby authorize representatives oft ' c unty to enter u thea ntioned property for inspection purposes.
Qate Signature (Applicant or
Page
2
Application Number . . . . . 04-00004706 Date
6/02/04
-----------------------------------------7----------------------------------
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
Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary
------------------
Permit
---------------=Permit Fee Total
Plan Check Total
Grand Total
Charged Paid
---------- ----------
273.00 .00
136.65 .00
409.65 .00
Credited
.00
.00
00
Due
273.00
136.65
409.65
06/09/04. 16:58 CDFARIFACOSTAMESA � 7607777011
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