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04-5229 (RPL)Tjhf 4 4 Q" P.O Box 1504 RNK�Of_ 78=495 CALLS TAMPICO -�I'r�A 'QUINTA, CALIFORNIA 92253 JUL 4 U - 1 2004 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 1 CITY OF LA QUINTA FINANCE DEPT. , Application Number . . . 04=0Date 6/29/04 Property Address . . 79755 LIGA APN: 772-230-053-53 -24890 - Application description POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 13000 Owner Contractor ------------------------ RAYMOND DUMSER ------------------------ CALIFORNIA POOLS & SPAS 79755 LIGA P.O. BOX 1.280 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 ------------------------------------------------------------ Permit *. . . . . . BLDG.POOL PERMIT Additional desc Permit Fee . . . . 144.00 Plan Check Fee 93.60 Issue Date Valuation . . . . 12783 Qty Unit Charge Per Extension BASE FEE 45.00 11.00 9.0000 ----------------------- THOU BLDG 2,001-25,000 99.00 -------------------------------- 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 -------------------------------------------------7-------------------------- 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 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Architect or Engineer: r, i VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer's Address: Lic. No.: BUILUINU PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed underrNo. ns/of Chapter 9/ (commencing with Section 7060) of Division 3 of the Business and Professionals e, and my Liceqq�e is in I force and effect. `///t!�S-�o License Class f . S . /t Licer� 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 contractors) 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 Xof the work for which this permit is issued. _ I have and will maintain wo ers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is is su d. M rkers' c pensation i ance carrier an j I''cy ur�bei a e: �rtier /ffolicy Number _ I certify t at, 11-151 the ortnance of the work for which t s ued, 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 Ih Id becom subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those prOisions. WARNING: FAILURE TO SECURE WOf�YiCERS' COMPE AT OV CRAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED T)9OUSAND DOLLAR ($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 Cityof La Quints, its officers, agents and employees for any actor omission related to the work being perfo nder or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is of mmenwithin 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellp0ion. I certify that I have read this application and state that the above info .on is cc I a to compl with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to n r upon the v ntioned party for inspection purposes. flD� gnature (Applicant or Agent): I 13 Page 2 Application Number . . . . .. 04-00005229 Date 6/29/04 ----------------------------------- 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 3.0.000 EA PLB WATER INST/ALT/REP 3.00 1.00 3.0000 -----_----------------------------------------------------------------------- EA PLB GAS PIPE 1-4 OUTLETS 3.00 Permit . . . . . WALL/FENCE PERMIT Additional desc Permit Fee 15.00 Plan Check Fee .00 Issue Date . . . . Valuation 217 Qty Unit Charge Per Extension -------------7-------------------------------------------------------------- BASE FEE 15.00 Special Notes and Comments POOL/SPA, 10 L.F. 5' BLOCK WALL, CITY. STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION.. Fee summary Charged ----------------- Paid Credited Due ---------- Permit Fee Total ---------- 261.00 ---------- .00 .00 ---------- 261.00 Plan Check Total 119.10 .00 .00 119.10 Grand Total 380.10 .00 .00 380.10 13