04-3706 (RPL)i
V BUILDING & SAFETY DEPARTMENT
P.O. R X,1504 ,
(760)'777-7012
79-495 tiCALLETAMPICO
,i.
-77 -701.1
T
LkQUINTA; CALIFORNf 92253 . -INSPECTION REQUESTS (760),777-7153
BUILDING PERMIT t
Application
Number 04:-00003`706= Date 4/26/04
Property Address
`` '. ' ' 54140 AVENIDA• ,RAMI-REZ
APN:
774=212-:007` 18 -00,0000-
Application
description 'POOL. -,.RESIDENTIAL
Property Zoning;
„ COVE RESIDENTIAL
+•
Application
valuation. t' 12:50:0
Owner`-
.n Contractor
BUFFI°N THOMAS
ADDINGTON,_- DAVID
P:. Q `BOX .134;'
. a ; 41.760 {H'ERM3TAGE "DRIVE
LA QUINTA .
"2.53 INDI.O.:
CA 92201
y. .. WCC , STATE FUND
U
WC.. ,2.290019787
01/01/05
CSLB:~' 682901..
'12/31/05
x.. CCC: g`
-
Permit
MECH POOL
Additional
desc
Permit Fee.
24 r00 `Plan :Check. Fee
6.00-
Issue Date
Valuation
.a .
0
`
Qty -Unit Charge . Per *Extension
Extension
_ .... BASE FEE
15.0
1.00
9.0:000 EA, .._ , MECH, FURNACE <=100K
9.00
Permit
BLDG POOL PERMIT
Additional
desc
Permit Fee.
144:00; :Plan Check Fee
93.60
Issue'D`ate
Valuation . . . .
12500
Qty Unit Charge Per
Extension
BASE FEE-.
45.00
11.009.°0.0.00,
°THOU. BLDG..' 2, 0'01-25; 000
99.00
Permit
ELEC POOL PERMIT -RES
Additional
desc
Permit Fee
.45,:0,0 Plan Check Fee
11.25
Issue Date.
Valuation
0
Qty _Unit,.Charge Per
Extension
BASE FEE, :; ..
15.00
.1.00
30:0000 EA--EL91yPR°IVATE`SW:I:MMING POOL
30.00
P.O. BOX 1504 a l�r��
VOICE (760) 777 -?012
7E-495 CALLE TAM►ICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 440
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: C2 Q — oc�40 3 76 O
Applicant:
Applicanus Mailing Address:
L11- ACV?
.Y y� o .
Date:
Architect or Engineer.
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
Code. and my LIu1 brew and
1 hereby affirm under Penalty ll perjury that 1 am icatsed under provkiorts a Chapter 9 (=mwn ft wkh Section 7000) a Division 3 a to Business and Pmkssionalsfoena t;,jn Nfect /�
License Cuss LS �License No. _ O �d /
Dab - G ContractorOWNPt
I hereby shin under penalty a perjury riot I am '8 R DECLARATION
city or county List reQuias a pennk b caratrtrd, roto ria contracIOM Shfe License Law for to bkowirg mason (Sec. 7031.6. Business and Professions Code. Any
st"n"
that ehe k �� irpvft. do-torrstt, «repair any structure. prior b is, ksuance. also requires to applicant fa to Pennk b Bea signed
and Pr" thathe Code) «tat la « b ria proviaiora a to Comtracbrs' State Uoenae Law (Chapter 9 (oormorreing with Section 7000) a Division 3 ata awkwas
the appiant b a dvi ex°" i t undr ore and the basis for to *Gaged sxerrptiar► Any violation a Section 7031.5 by any applicant for a pan* subjects
U I. as owner ata t . riot nam tan ive bandied dotsrs (f5o0).):
Property. or my �+PloYsos with wages as rieir $ole oonpensaion, will do to work. and Ila skucl rs Is not Intended or aft for sale (Sec 7044.
Business and Ptofessiorts Code: The Corrtracsors' State License Low does col apply b an owner a property who builds «improves tereon, and who does to work
sold withhirnsaffin ado or t rough hit «her own employees, provided tot to imprwemeeys are not k*Mded « offered for sale. K. however. the building «irpovemam a
U Las owner a to Y� a . the ow"�� "'� �e to burden a proving ricer he or she did not build « improve f« the purpose a sale.).
ith
Stab License Law does nPOPertynot gxduwvh oomadirg property
w sed contractors bon
ostrud to pojed (Sec. 7044. Business and Professions Code: The Contactors'
the Contractors' State license Law.). o b
appy b an owner a property whuilds «improves tefw% and who contracts for the projects with a contractw(s) ioensW prant bsu
U I am exempt ander sec . B.& P.C. for tis mason
Dab owner
1 hereby atripn under penalty a penjuy one a to WORKERS'COMPENSATION DECLARATION
t/ 1 love and will maintain a Certiiate of Consent to for workers'
a the work f« which tis permit is issued 0°"'pe" 0^• as provided for by Section 3700 of the labor Code. for the pertonmanoe
_ I have and will maintain workers' compensation haws tce, as required by Section 3700 of to Labor Code. for the performance a the work for which tis pemkll a
issued. sM workers' comPensaion Insurance canier and poik�r rturtber are:
Cartier Pok
I eertdy ttatV Number
in the performance a to work for which Us pertM a issued. l shale not ertkpbY any person in any manner to as to beton WbOd to to workers'
��y and apes tot r 1 should become subject b or
tdhwkhMo wkcers' compensation provisions a section 3700 a to Labor Code. l shag
w
Dab q_ 2-7- -o L/ Appiant �
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUMMED THOUSAND DOLLARS (i100.000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. .
1 hereby atrum coder penalty of perjury that temk a Construction�CONSTRUCTION LENDING AGENCY
g agency for the performance of the work for which rife Pen it is issued (Sec. 3097. CN. C.).
Lenders Name
Lender's Address
IMPORTANT Appkstion is hereby made b the Dirodor of APPLICANT ACKNOWLEDGEMENT
1 Each t+D� behalf
Building and Safety for a permit subject b ate wniditions and restrictions set forth on tis appicatiort.
Issued es •result a tis a front k made, each person at whose request and f« whose benefit work k performed under «purswnl b any peM
it
s and ppication,m owner. and the appieartt, each ,groes b. and shalt, detnntd, irtdenrurtify and hold penniless the Citya La Ouhh, ks
employees thi a ad « omission related to the works
2 MY Petrel issued as a result a this application becomes nu0 and void k wort�rq performed
w„irtunl�W�days .from drat d ksusnoe a such permit «
cessation a work for 140 days wN aubjed peril b cancepalion.
1 certify that I have read tis application and state that the above intimation Is correct- 100 to comply with alt city and county ordinances and state laws
relaiing
conStruction. and hereby suMorre representatives a ails county to enter upon the above- mentioned property for inspection purposes. b building
Date Signature (Appfmtt or Agent):
pk
- ,�, a,`?nt;l(Fc�•?.nrv.'��:°�,I1;+yHi4"�+j��YI�''6}��t+rL.li��ia�" -
fel. •� .. ..
-
Page 2
Application Number 04-00003706
Date 4/26/04
- Pe rmi t PLUMBING
Additional.des_c
Permit Fee 33 00 Plan Ch°eck Fee
8.25
Issue Date Valuation
0
Qty Unit Charge .Per.
Extension
_ BASE FEE..
15.00
2.00 6- 0 0 0 0 :;`EA . PLS' FIXTURE; •-
12.00
1.00 3. 0 0 0 0EA'. PLB MATER ' IoNS T/•ALT/; REP
3.00
1.00 3.0000 .;EA .... PLB'°.GAS `PIPE 1=4 i OU>TLETS,
3.00
----- .-- --. - - - - --
Special Notes .and 'Comments-, ' vy
POOL ::& SPA ONLY P;LARMS BARRIERS, SHALL
BE, IN PLACE `PRIOR` TO PREPLASTER
INSPECTION.
Fee summary Charged'''" Paid.. Credited
Due
• Permit Fee; Total 24`6':00.'- .00'f•- .00
24.6'.00
Plan -Check Total 119.16 00 .00
119.10
Grand Total 36.5.:10, .00- .00
• r
365.10