04-4844 (RPL)0�
�.' BUILDING & SAFETY DEPARTMENT
,J` arc �+ `"�O.• Box 11 X04 , (760).777-7012
cFMp JUN:l �6 t4,i .cA�zE TAhtPlco FAX (760) 777-7011
La QUIN- A;CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
CITY.OF LA QUINTA
FINANCE DEPT. -BUILDING. PERMIT. '
Application •-Number 043 Date 6/;09/04
Property Address 52334.AVENIDA RUBIO
APN: 7.73.--2-5.3-024-20 -000000-
Application description `:` 'OL." RESIDENTIAL
.Property Zoning COVE RESIDENTIAL
Application valuation . . . 20000'
Owner Contractor
BARAJAS LARRY OWNER
.52334,AVENIDA RUBIO
LA QUINTA CA 92253
Permit : ' BLDG_ POOL' PERMIT'
Additional desc
Permit' FO'e'. 2.07'.00 Plan..Check Fee 134.55
Issue .Date Valuation`: 20000
Qty Unit Charge Per Extension
BASE FEE 45.00
18.00 .9.0000 THOU BLDG 2,001-25,000 162.00
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 9.00'00 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 ItLEC.''PRIVAT E SWI,MMING;S.POOL 30.00
Permit. . . . . . . PLUMBING
Additional desc
Permit Fee ....33.00 Plan Check Fee 8.25
P.O. Box 1504
78-495 CALLE TAMPICD �` � VOICE (760) 777 ;_701:
LA QUINTA, CALIFORNIA 92253 FAX (760) 777.'01 i
INSPECTIONS (760) 777-71 c:
BUILDING 8 SAFETY DEPARTMENT
Application Number: _ 14 f('q`t Date:
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
I Hereby affirm under penaltyof LICENSED CONTRACTOR'S DECLARATION
perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Ptofesswnals
Code, and my License is in full force and effect.
License Class License No.
Date Contractor
I herebyaffirm under OWNER -BUILDER DECLARATION
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,
Bu iness 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
self or herself or through his or her own employees, provided that the improvements are not intended or offered for safe. If, however, the buildingor
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 u "^pfOV°^1°nt is
I, as owner of the property, am exclusiyely 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 La
U I am exempt under Sec. B.& P. or " ason
Date ner
I hereby affirm under WORKERS' COMPENSATION DECLARATION
Y 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 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
Carver
issued. My workers' compensation insurance carrier and policy number are:
Policy Number
_ I certify that, in the performance of the work for which this permit is issued. I shall not employ anme subject to workers
compensation laws of California, and agree that. if I should become subject to the workers' compensation Provisionsyrof SSo aection3700 of the Laborthat Code. I shall
forthwith comply with those provisions.
Date Applicant
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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury that there isa construction lending agency
LENDING AGENCY
Lenders Name
for the Performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
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 Ouima, its
officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
cessation of work for 180 days will subject permit to cancellatio .�^� mak^ 110 dsyti from date of issuance o1 such permit or
I certify that I have read this applicabori and state that the above info " on is co I agree comply with all city and county ordinances and state laws
construction, and hereby authorize representatives of this cou ty to en r upon thea relating t0 buUdinp
ed property for inspection purposes.
Date
�ignatum (Applicant or Ag nt):
'�Y;'
R: fi !
1
Page 2
Application Number 04-0000484.4
Date. 6/09/04
Issue.Date Valuation. . .
. . 0
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 6.0.0 0 0 EA • PLB" F I�XTURE
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
Special Note's -and --Comments
POOL/.,SPA. ALARMS/ -BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION,
EQUIPMENT ENCLOSURE. �NOT.INCLUDElj
Fee summary CYarged` Paid j Credited
Due
Permit Fee Total' 309.00 .00 .00'
309.00
Plan`�Check Total :... 1:6.0:05 00 00
160 A5
Grand 'Total 469:-05. .00_ ..00.
469.05
Ave 1Z Lk