04-7521 (RPL)Tdf
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO • FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . 0,4.-00007521 Date 12/01/04
Property Address h 79827 CASTILLE DR
APN: - 609-380-99.8-33..,322=
Application description . . . POOL - RESIDEN,TIaOtAL,_/i�•s__
g
Property Zoning . . . . . . . LOW DENSITY RESIDw,.ENTIAL {S
Application valuation . . . . 33000 E�v ® 2004
Owner ContractorCjTynFLAQ01"T"
-------------------------------==--- rw.iivl^s�� ----
JEANNIETTIES CAL-NEV POOL, INC.
79827 CASTILLE DR P.O. BOX 2222
LA QUINTA, CA RANCHO MIRAGE -CA 92270
LA QUINTA CA 92253 (760) 883-5561
WCC: STATE.FUND.
WC: 2290022990 01/01/05
CSLB: 777601. 04/30/06
CCC: C53
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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
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Permit . . . . . .. BLDG POOL PERMIT
Additional desc
Permit.Fee . . . . 304.00 Plan Check Fee 197.60
Issue Date . . . . Valuation . . . . 33000
Qty Unit Charge Per Extension
BASE FEE 252.00
8.00 6.5000 THOU BLDG 25,001-50,000 52.00
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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
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
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Permit . . . . . . PLUMBING
Additional desc
P.O. BOX 1504 ����
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0 If - `ram- / I I Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engin is dr
f,
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
Code, and my Licensg is in f f ce and effect. f
License Class G License No. ? 7C5 a
• - ..Intractor
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, after, 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 fhe 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 viotation of Section 7031.5 by any applicant for a permit sutl ects
the applicant to a cMf penalty of not more than five hundred dollars ($500).):
L) 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 a impmve for the purpose of sale.).
it 1 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.).
�} ! am exempt under Sec. , $.& P.C. for this reason
Date
Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
SALled. orkers' cempen on insurance carrier and policy number are: �.
Carrier /"111/1 policy Number-
Ideiti that, in tm once of the work for which this prmift is issued, s a 1 not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions. - _
y
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($I00,000), 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 5uiIding and Safety for a permit subject to the conditions and restrictions set forth on this application.
1, Each person upon whose behalf this appllcaflon 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, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any actor 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 oommenced within 180 days from date of issuance of such permit, ar
cessation of work for 180 days will subject permit to cancellation.
I certify IheI I have read this applicatlon 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 a ve-mentioned p party for inspection purposes.
Da
Signature (Applicant or Agent):
w
Page 2
Application
Number . . . . . 04-00007521
Date 12/01/04
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
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Special Notes and Comments
POOL & SPA ONLY.. ALARMS/BARRIERS
SHALL
BE IN PLACE
PRIOR TO PREPLASTER
INSPECTION.
EQUIPMENT ENLCOSURE
NOT
INCLUDED IN
PERMIT.
Fee summary
Charged
Paid Credited
Due
Permit Fee
Total 406.00
.00 .00
406.00
Plan Check
Total 223.10
.00 00
223.10
Grand Total
629.10
.00 .00
629.10
is J
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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VICINITY MAP
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE -L . a .o`1BY
POOL SIZES S_o�om3 �h x
MA IMON Access &Wft_
ltfrom Obstacles
Vhl s Ponvred Reowed
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kin so c Sing OW sell D "P� code. - ��.
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?`NOTE Wet down st�e11 At Mast thrice dilly br savari days 9W 9"ll a e1 ailed CRY P� SOLD
have ieriew this.tplan WKI Iter approve total plan Jl<spe s. p}lp(11E
-ORAVYN _-4—
PATE.,
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• SIGNATURE
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