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RPL (04-4389)4 BUILDING & SAFETY DEPARTMENT ox 1504 (760).777-7012 CALLE TAMPICO - FAX (760) 777-7011 INTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number. 0-4-00004389-. -' Date 5/18/04 Property Address . . . . . 51542 AVENIDA--NAVARRO APN: 773-145-003-22 -000000- Application description . . POOL - RESIDENTIAL Property Zoning . . . . COVE RESIDENTIAL Application valuation . . . . 12000 Owner Contractor JOSEPH 13IRDSELL BIRDSELL BUILDERS, JOSEPH 35558 SUMMERLAND.AVE. 35558 SUMMERLAND AVENUE PALM DESERT CA 92211 PALM DESERT CA 92211 (760) 360-2301 WCC: DAUGARD INS WC: 22946491 11/01/04 CSLB: .811293 08/31/05 CCC: B ---------------------------------------------------------------------------- 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 . . . . . BLDG POOL PERMIT Additional desc Permit Fee 135.00 Plan Check Fee 87.75 Issue Date . . . . Valuation' 12000 .Qty Unit Charge Per Extension BASE FEE r 45.00. 10.00 9.0000 THOU BLDG 2,001-25,000 90.00 ---------------------------------------------------------------------------- Permit . . . ELEC POOL PERMIT -RES Additional desc Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date . . . Valuation . . . . . 0 Qty Unit Charge Per 1.00 30.0000 EA BASE FEE ELEC PRIVATE SWIMMING POOL Extension 15.00 30.00 P.O. BOX 1504 78-495 CALLS TAMPICO Y VOICE (760) 77 7 -70 12 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Wt .l Architect or Engineer: Architect or Lic. No.: BUILDING PERMIT DECLARATIONS Date: ress: , 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 is f full force and effect. License Class J % License No.% 3 Date — 'Y'i Contractor J6:3 ��%� m ��! rJ S LS "GU / Z_ 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 sdle 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. , 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. _ 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: Carrier %,iJ 4 e -,A n 0 / iu -t Policy Number 2 2 C- !,L 4 17 _ 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, I shall forthwith comply with those provisions. Date �� /45 " G 4 Applicant 3 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. 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 IMPORTANT Application iAPPLICANT s hereby made to the Director of Buildin and Safety ACKNOWLEDGEMENT 1.. Each person upon whose behalf this application is made, each person at whose request t anto d for Moose benefions and work isperformedunder or pus set forth on this rsuant 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 tante ation. I certify that I have read this application and state that the abkv"!tt" inis Erect. I agree to corn ly with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this cote upon a above-mentioned pr party for inspection purposes. Date Signature (Applicant or Agent): , Page 2 Application Number . . . . . 04-00004389 Date 5/18/04 Permit . . . . PLUMBING Additional desc Permit Fee 33.00 Plan Check Fee 6.75 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 3.00.00 EA PLB GAS PIPE 1-4.OUTLETS 3.00 Special Notes and Comments POOL & SPA ONLY. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. Fee summary Charged Paid Credited Due Permit Fee Total 237.00 .00 .00. 237.00 Plan Check Total 111.75 .00 .00 111.75 ' Grand. Total 348.75 .00 .00 348.75 /SS/2v`= N•oV�2Ro FILL,- "^ ,4 7'/' fa . . I j r• / ` "f i pool S �l oo! A .RE-] SP I0 FEE $30 !,� s PA WILL BE CHA D I THE AP ROVED PLANS ND.J C RD ARE OT P' « � THE S TE ff. R . q SCII INSPECfiION. ITY OF LA �� 1 �j r I `R ...r 'I ` .. � n i BUILDING CCY�'r