04-6315 (RPL)Tldf 4 4 agurcy
BUILDING & SAFETY DEPARTMENT
P.O. Box .1504 (760)•777-7012
495 CALLE TAMPICO FAX (760) 777-7011
aA QUINTA, CALIFORNIA 92253 .INSPECTION REQUESTS (760) 777-7.153
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BUILDING PERMIT
lca°tion umber 04-00006315 Date 9%15/04
rop ress . . . . . 48410 CASITAS DR
APN: 649-382-0.24- - -
Application.description POOL - RESIDENTIAL
Property Zoning . . LOW DENSITY RESIDENTIAL
Application..valuation 10.000
Owner Contractor
M/M ROOS CALIFORNIA POOLS & SPAS
48410 CASITAS DRIVE P.O. BOX 1280
LA QUINTA CA 92253 COACHEL4A CA 92,236
(760) 398-9222
WCC STATE FUND
WC: 0460.0061168 01/-01/05
CSLB: 656128, 10/31/04
CCC: -C8-C2'7-C29=C53
-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..
1.0.0 9.0000 EA MECH FURNACE <=100K 9.00
Permit.. BLDG POOL PERMIT
Additional desc
Permit Fee . . . 11.7,.00 Plan Check Fee 76.05
Issue Date Valuation 10000
Qty Unit`Charge- Per Extension
BASE FEE 45.00'
8..00 9.0000 THOU BLDG 2,001-25.,000 72.00
Permit .. . . . . . E__LEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 45.00 Plan Check Fee 11.2.5
Issue Date Valuation. 0
Qty Unit Charge Per Extension'
BASE.FEE 15.00
1.00 3:0.00'00 EA EL'EC PRIVATE SWIMMING POOL 30.00
•
P.O. Box 1504 VOICE (760)777-7012
78-49.5,CALLE TAMPICO FAX (760) 777-7011
LA QU.INTA, CALIFORNIA 92253 INSPECTIONS (760) 777-71153
BUILDING & SAFETY DEPARTMENT
Application Number. C>j� (a 3lJ� Date:
Applicant: ` Architect or Engineer.
Applicant's Mailing Address:
Architect or Engineer's Ad S:
7;F:
Uc. NO.:,
BUILDING PERMIT DECLARATIONS
- LIC SED CONTRACTOR'S DECLARATION
1 hereby.affirm ander penalty of perjurythat) em licensed under p of Chapter 9 (commencing with Section 7000) cf DMsIon,3 of the Business and Professionals
Code, and my Lloeme Is in 0 force and effect.
License Class, C:77S-. se o. 10
Date Contractor A,,e4l
I hereby affirm under penalty of perjury that I am �E s! State License
DECLARATION
exempt from ntracters' State LJcense Law tenths folbwing reason (See. 7031.5. Business and Protessbrrs.Code: Any
city or county tl0 requires a perm to construct, after, improve. demolisk or repair any armature, prior tans issuance. also requires the applicant for tins permit to Me a signed
statement thal,he or she_is licensed pursuant to the priovisions of the Contractors State License Law (Chapter 9 (commencing with Section 7000) of.Division 3 of the Business
and Professions Code).orthat to orshe, is exempt therefrom and the. basis for thwalleged.exemptiam Any violation of Section 7031.6 by any applicant fore permit subjects
the applicant to i civilpsnafty of not more than live _hundred dollars ($500).):
0 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 Bele (Sec. 7044.
Business and.Protessions Code: The Contractors' $tate License Law does not apply m an owner of'properly who builds or improves thereon. and who does the work
himself or herself or through his or her awn employees, provided that the kriprovements are not Intended or offered for sale. If. however. the bullding.or Improvement is
sold wilhin.one year ofcompletion. the owner4xdlder witi,have.the burden of proving.Ihat he or she did'not build or kmprove for the purpose of sale.).
U I. as owner of the property. am exc uaively contracting with licensed contractors to construct the project (Sec. 7044, Business and Processions Code: The Contradors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License law.).
C-) I am exempt under Sec. ., B.& P.C. for this reason
Date Owner
WORKERS' COMPENSATI.O_N DECLARATION
t hereby affirm under penalty of perjury one of the foiiowing.declarafions:
—I hav&and will maintain a oertirccate of consent to self: insure for workers' compensation. as provided for by Section 3700 of the. Labor Code, for the performance
of the work for which this permit is issued.
_ I have:and will mal In rkers' compensation insurance, as, required by Sediotr 3700 of the Labor Code, for perfo mune of ihs work for witch this permit is
iss ed. ricers' ompensedon insurance carrier licy nu "rye
Cartier Policy Number_
'certify in the performance of the work for which thi 8rntt is and. I shall notemploy any person in,any manner so'as to become subject tore workers'
compensation Ism of California,•and agree that. I Id bil subjectlo the workeW compensation provisions of Section 3700 of the Labor Code„ tehall
f0rdWftcoMpIyWlh#=eprpQSIca8.
Data / O Applicant ,
WARNING: FAILURE TO. SECURE WOR ERS' COMP ION GEIS UNLAWFUL, AND SHALL SUBJECT AN. EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (tt ,00.0), ADdiTION TO THE COST OF COMPENSATION, DAMAGES A$'PROVIDED FOR IN
SECTION 37dkOF THE LABOR;CODE. INTEREST..AND ATTORN ES.
CONSTRUCTION LENDING AGENCY
1 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. 3067. 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 sel1orth on this application,
1, Each parson 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 shell. defend, indemnify and hold harmless the City of Le Quhta. 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 pemdt issued.asts resukof this application becomes null and void 't work oed witMn 180 daywfrom date of issuance of such permit„ or
cessation of work for 180 days will aubject permit to cancellation.
I certify thanl have read this;application and state that the above Infornadon'le correct roe to ply with all city and county oMirma toes and state laws relating to buildh►g
construction, and hereby, authorize representatives oc this county- ter upon the ed properly for inspection purposes,
Date Signature (Applicant or Agent):
Page 2
Application Number . . . . . 04-000063'15 Date 9/15/04
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Permit . . . . . . PLUMBING
Additional desc . .
Permit Fee . . 27.00 Plan Check Fee 6.75
Issue Date . . . . Valuation 0
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
1.010 3.0'000 EA PLB GAS PIPE 1-4 OUTLETS 3.00
Special Notes and Comments
SPA ONLY. ALARMS BARRIERS 'SHALL BE
IN PLACR PRIOR TO PREPLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED IN
PERMIT.
Fee summary Charged Paid Credited, Due
Permit Fee Total 213.00 .00 .00 213.00
Plan Check Total 100.05 .00 .00 100.05
Grand Total 31.3.05 .00 .00 313.05
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