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04-5174 (RPL)l • .BUILDING & SAFETY DEPARTMENT P.6'. ­B qx 1504 ,Y {'. (760).777-7012 78-495 CALLE TAMPICO ' °' FAX (760) 777-7011 .LA QUINTA,, CALIFORNIA 92253' IN:SPECTIO'N REQUESTS (760) 777-7153 BUILDING•PERMIT - ,W',at ; AK 3 2004 Qty Unit'Charge Per Extension GIT! OF LA9UINTA F(MANCt 0 PT. Application Number . . . 04-000:0:5';174Date �-- - . - 8/19/04 Property Address 53100.AVENIDA. RUBIO APN: 7-74.:04'3''-00'5,7,2.0 .--000000- -000000-Application Application description POOL -`RESIDENTIAL Property Zoning COVE,RESIDENTIAL Application valuation 1-200'0 Owner Contractor. POWER FINANCE PICAZO POOLS & SPAS P.O. BOX 134 823!65 HIGHWAY 111, SUITE #101 LA QUINTA CA 92253 INDIO .' CA 92201 (76:0). 347-5855 'WCC-: EXEMPT* WC: EXEMPT 05/31/05 CSLB:. 8'3'6900 04/30/06., .CCC.; -�.C:5 3 ------------------------------------------------------------------------------ Permit. . . . . . . BLDG POOL PERMIT Additional desc Permit Fee 135.00 Plan -Check Fee 87.75 Issue Date Valuation 12000 Expiration Date 2/19/05 Qty Unit Charge Per.. Extension °.BASE FEE 45.00 10.00 9.0000* THOU BLDG 2, 00:1`-.2.5, 000. ,. 90.00 Permit ,ME'CH POOL Additional desc . Permit Fee 24.-.0'0 Plan Check Fee 6.00 Issue Date Valuation 0 Expiration Date 2/:19/0'5 Qty Unit Charge Per_° Extension BASE FEE 15.00 1.00 9.0000.EA. MECH FURNACE <=100K 9.00 Permit . . . . . . ELEC POOL.PERMIT-RES Additional desc Permit Fee 4=5 0:0 /1 n- Plan Check Fee 11.25 Issue Date ID' /�. , , Vail `�at.ion 0 Expiration -Date 2/19/0.5 AK 3 2004 Qty Unit'Charge Per Extension GIT! OF LA9UINTA F(MANCt 0 PT. P.O. BOX 1504• '�C��/i . w VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Dates Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS A)14 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 Licgns�is in full force and effect. / �Cicense Class [ 1S License No. bate "2-3-49 Y fftontractor / 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 contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec., B.i3 P.C. for this reason Date 9'? 3 0 �_f 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 Policy Number 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. ;W11XM 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 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 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, indemnify and hold harmless the City of La Ouinta, 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 cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating t construction, and hereby authorize representatives of this county to enter u on the above-mentioned property for inspection purposes. o building ate 8 ? �� ignature (Applicant or Agent): Page 2 Application Number 04-00005174 Date 8/19/04 Qty Unit Charge Per Extension BASE FEE • 15.0 0 1.00 30'.01.000 EA_. ELEC•PRIVATE SWIMMING POOL 30.00 Permit PLUMBING" Additional des,e Permit Fee 27..00 Plan Check Fee 6.75 Issue Date Valuation . . . . 0 Expiration Date 2°/,19/05 Qty Unit Charge. per ': Extension BASE .FEE 15.00 1...0 0 6.0:0 0 0 EA •PLB, F.IXT•URE .. 6.00 1:00 30.000 EA.= PLB WATER-INST/ALT/REP 3.00 1.00 3.0000 -'EA'- r'PLB GAS PIPE 1-4 OUTLETS 3.00 :Special Notes' and Comments POOL ONLY.ALARMS/BARRIERS SHALL BE IN PLACE- PRIOR, TO PRE`PILAST-ER . INSPECTION. EQUIPMENT;'ENCLOSURE NOT INCLUDED IN PERMIT.' Fee summary Charged Paid Credited Due ---------- ---------- ---------- Permit Fee, Total, 231.'0`0 .00 .00 ---------- 231.00 Plan Check Total 111.75 .00 .00 111.75 Grand Total342t':75 0.0°, .00 342.75 • r CITY OF LA QUANTA BUILDING & SAFETY DEPT. APPROVED F R ONS FRUCTION A RE -'INSPECTION FEE PROVED WILL BE CHARGED IF. THE APPROVED. PLANS AND JOB CARD .ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. 1pomm.FMANCE 6 I 1 ''i�➢�1��A� Ei9ii - �i. CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS PERMIT NUMBER OWNER BUILDER f 1� X2-0 04c,,,1,,,_ This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the. Building Division prior to commencement of work. Fail a to com ly will result in as stoppage of work and/or the voidance of hiiilrlinn nPrmit- For aarh annlirahlP traria- all informatinn raniiPctPrl halnw mist hp rmmnlPtarl by annlirant �."nn Fila" is not an arrpntahle rcaennne- o •� rte- - Trade / Classification --- -rr- - - - -- - Contractor - - --- - - -- •r-- -- State Contractor's License -i "rr• ..�... ..r.,,.. �1lorkers Com ensation Insurance City Business License Company Name Classification : (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) }�.I%L6il C� 0.i (✓—i 2- -4c 05 ;5TNr f 3 o. CONCRETE (C-8) s� LY 9ZLYS d7G� S-rP `, P11. I 0 FRAMING (C-5) STRUCT. STEEL IC -511 �lGaZ . r=J 5TVA& 9COub e.- `a3 9 r 4:04 t MASONRY (C-29) PLUMBING (C-36) tc.-A "r.&L Pblo L5Z' `j �O� : ®feu I .�.�i �`.. -7! ©�S LATH, PLASTER (C-35)<• .- DRYWALL (C=9) HVAC (C-20) ELECTRICAL (C-10) 'A . to a, ® -,C6 71 2(P1 ROOFING (C-39) SHEET METAL (C-43) ^ FLOORING (C-15) GLAZING (C-17) .INSULATION,( C-2) SEWAGE DI$Q. (C-42) PAINTING (C-33) CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) LANDSCAPING (C-27) POOL (C-53)tPi> t� Pv 6� �� 2 ��%+`� 1�. FL, - 4 Nil