RPL (04-5436)l'
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number '.
. . . . 04-00005436 Date'
7/13/04
Property Address . .
... . . 51520 AVENIDA NAVARRO
APN:
773-145-002-23 -000000-
Application description . . . POOL - RESIDENTIAL
Property Zoning
COVE RESIDENTIAL
,Application valuation*.
11500
Owner
Contractor
ANDREWS BRUCE R
MASTER POOLS AND SPAS
51520 AVENIDA-NAVARRO
'73555 HIGHWAY 111
LA QUIN.TA
CA"9225.3 PALM DESERT.; CA
92260.
(7 60) 346-6115
WCC: STATE FUND
WC: 157.6431
07/01/05
CSLB: 2389.47
03/31/05
CCC: C53. .
Permit
BLDG POOL PERMIT
Additional desc
Permit Fee . . . .
135.00 Plan Check Fee
87.75
Issue Date . . . . .
Valuation
11500
Expiration Date,
1/13/05
Qty Unit Charge
Per
Extension
BASE FEE
45.00
10.00 9.0000
THOU BLDG .2,00.1-25,000 ;.
,,9.0.00
Permit
ELEC POOL PERMIT -RES
Additional desc
Permit Fee . . . ..
45.00 Plan Check'Fee
11.25
Issue Date
Valuation
0
Expiration Date..
1/13/05 1.
Qty Unit Charge
Pere
Extension
BASE�FEE
15.00
1.00 30.0000
EA ELEC PRIVATE SWIMMING POOL
30.00
Permit
PLUMBING
Additional desc
Permit Fee
27.00 Plan Check Fee
6.75
Issue Date
Valuation
0
Expiration Date
1/13/05
Qty Unit Charge Per Extension
P:O. Box 1504 • ��G��/
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: Dq- 5�3�
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
Architect or Engineer's Address:
AD IA.
Lic. No.:
BUILDING 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
and my License is in full force- and effect.
-,"License
/ 9-3'3
J/ 9 7
Class •G �� incense No.
/gate `7-13 -y' 1/ torl"(.F-sT" P, le S 41
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. . 1 , 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 seiNnsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
-9. 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 for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Cartier SS%rte F'v t Policy Number `�� !r -< J
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 the workers'
compensation. laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, l shall
forthwith comply with those provisions.
c
pli
WARNING: FAILURE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUND D 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, indemnity 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.
1 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
construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
Date —E7 Signature (Applicant or A �`�
Page 2,
Application Number . . . .' .
04-00005436_
Date 7/13/04
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 6.0000 EA PLB
FIXTURE
6.00
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. ALARMS/BARRIERS SHALL BE
IN PLACE
AT PRE -PLASTER INSPECTION. EQUIPMENT
ENCLOSURE NOT INCLUDED
Fee summary Charged
-- - - - - - - - - - -- - -
Paid
Credited
Due
------ - - - - --
Permit Fee Total .207.00
---- - - - - ---
.00
--- - - - - --
.00
---- - - - - - -
207.00
Plan Check Total 105.75
.00
.00
105.75
Grand Total 312.75
00
.00
312.75
v.
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IdentlflGatiOn Inforxnatlon ilh
Assessment Number: ?13145002-11 yN
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WA
By on�9
` 4
01-W-04Tax
Property Typa: Real p
Rate Area: Lo Quints W
-8111 Number: 000642584
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Address Information
Property Address:' 51520 AVENIDA NAVA4�RD LLA 11I�TA�� ��'���
F
BUILDING & SAFETY DEPT..
-�
APPROVED
LOT.23 ELK 110 MB O18/O'1a
SANTA CARMELITA AT VALE LA QUINTA NO SCR CONSTRUCTION
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\ GUSTOMER SIGNATURE DATE_
VICINITY MAp:
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