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04-3436 (RPL)• BUILDING & SAFETY DEPARTMENT 0., B o x 1504 4 (760) 777-7012 78-495 CA LE TAMPICO FAX (7,60) 777-7011 LkQUINTA, CALIFORNIA 92253,.,,: . INSPECTION REQUESTS -(760) 777-7153 BUILDING PERMIT '04-:00003.436 Application Number . . . .,.- 7 Date .4/12/04 Property Address ,�VEN;Ki; R-AM-iR, APN: 7731-222�L002-21 --.00000()�l Application description .POOL.. RESIDENTIAL j Property Zoning "COVE RESIDENTIAL F Application valuation. 15000: APR 13 20.04 Owner ------------ ------------ Contractor . L_ ------------------------- . �- 1-1 � �,,.?_ ;.A.Q1jbtATA 1 .1' 0; .�- -. DEPT BILLS RANDY C LEGACY -HOMES 54865 AVENIDA OBREGON .P..O.' 'BOX 696 LA QUINTA CA 9225.3 LA QU,INTA, CA .92253 .(76.0), 777-8317. WCC': NONE; WC: 'EXEMPT 05/31/04 CSLB: 778280 -05/31/04 -CCC': B -- - - - - - - - - - - - - - - -- - - - - - - Permit . . - - - - - - - - - - - - 7 - - - . ... MECH- POOL - - - - - - -- - - --- - - - - -- - - - - - - - - - - - - - - - - - - - Additional desc-. Permit Fee 24.00 P1an'Che6ik"Fee 6.00 Issue Date Valqati-04'<. 0 Qty Unit Charge, -PerExtension �BASE, -FEE, 15.00 1.00 9.0000,KA .M2CH,FURNANCE = ------------------------ .<=1,0,OK 9.00 - Permit . . . . -------------------- BLDG. POOL ,, PERMIT - Additional desc Permit Fee . . . .. 162.00 Plan Check:Fee 105.30 Issue Date . . . . . Valuation . . . . 15000 Qty Unit Cha'ri.ge -Per........ Extension BASE 'FEE45 -.00 13.00 9.0000 'THOU BLDG *2.,,001-25, 000 - 117.00 --------------------------- — -- ------------ ------------------------- - ------ Permit EL2'C�PbOL' PERMIT -RES - Additional desc .Permit Fee 45.'00 Plan.. Check. Fee 1.1,25 Issue Date . . . .. Valuation 0 Qty Unit Charge .Per Extension BASE, FEE 15.00 1.00 30:.:000'0 ------------------- % EA �iELEC ---------- ---------- PRIVATE-SWIMMING'POOL - -------------------- 30.00: ----------------- P.O. BOX 1504 • ��ca�w r1 VOICE (760) 78-495 CALLS TAMPICO FAX (760) LA QUINTA, CALIFORNIA 92253 4 INSPECTIONS (760) BUILDING & SAFETY DEPARTMENT Application Number: — 3 Date: Applicant: a21n/g;L Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS A� 777-7012 777-7011 777-7153 LICENSED CONTRACTOR'S DECLARATION 1 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 License ' in full force and effect. ! � License Class I icense No. Date C% �J—U� Cont2ctor L�P� G•�- / 'moi ��Y�9—] O t. 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 pemmit subjects the applicant to a civil penalty of not more than rive 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.). (, 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.). (.-) I am exempt under Sec. , B.&.C. for this reasor>n r Date , - j' 1 % 4 O 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 self4nsure 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: Cartier Policy Number _ I certify that, in the performance of the work for which this permit is issued, 1 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. 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 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.). Lenders 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. I. 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 Outnta, 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 pemmlt, or cessation of work for 180 days will subject permit to cancellation. I certity that I have read this application and state that the above inform 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 t ter u above orad property for inspection purposes. `Date ,Signature (Applicant or Agent) Page 2 Application Number 04-00;003436 Date 4/12/04 Permit PLUMBING Additionaldesc Permit Fee, 33.00 P,l'A ..,Check Fee 8.25 Issue Date Valuation. 0 Qty Unit Charge Per Extension 'BASE FEE.. 15.00 2.00' 6 ,. 0 00 0 . EA ' �PLB. F IXTURE ;.: 12.00 1.00 3,: 0000 EA PLB'.WATER ! INST/ALT/REP 3.00 1.00 3 `.0.'0 0 0 -EA PLB'l GAS PIPE: - 4 OUTLETS 3.00 ------------ Special Notes. and Comments POOL & SPA ONLY. _:ALARMS BARRIERS SHALL B EIN PLACE PRIOR TO PREPLASTER . ._ INSPECTION. Fee summary Charged Paid `, Credited Due -------------, -- ----- --- ---------------------- ---------- Permit .Fe.e Total; 264.00 0.0 00.. 264.00 Plan Check Total . 130.'.80 ;O,Of. `` .00 130.80 Grand Total 394,,.'80,: .0,.0 00 394.80