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04-6286 (RPL)w T-Ildf. 4 4 a" P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number . . Property Address . . . APN: Application description Property Zoning . . . . Application.valuation . Owner BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 ... 64-0-0-0 062 . . . 79817 BARCELONA DR 609-380-998-9 -2 POOL - RESIDENTIAL LOW DENSITY RESIDE: 15000 GREG POTIOUS 79817 BARCELONA LA QUINTA, CA LA QUINTA CA 92253 =De 9/13/04 e 2- `:EP 155 2004 C" OF LA QUINTA Contractor -- ------------------------ VACATION POOLS 9522 DONALDSON ROAD LUCERNE VALLEY CA 92356 WCC: STATE FUND WC: 2290019334 01/01/05 CSLB: 351673 01/31/05 CCC: C53 ---------------------------------------------------------------------------- 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 EA MECH FURNACE <=100K 9.00 ---------------------------------------------------------------------------- Permit . . . . . . BLDG POOL PERMIT Additional desc . . Permit Fee . . . . 162.00 Plan Check Fee 105.30 Issue Date . . . . Valuation . . . . 15000 Qty Unit Charge Per Extension BASE FEE 45.00 13.00 9.0000 THOU BLDG 2,001-25,000 117.00 ----------------------------------------------------------------------------- Permit . . . . . . ELEC POOL PERMIT=RES Additional desc . . Permit Fee . . . 45.00 Plan Check Fee 11.25 Issue Date . . . . Valuation 0 Qty .Unit Charge Per BASE FEE Extension 15.00 do P.O. Box 1504VOICE (760) 777-7012 T44f 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 6 t�— "aZ0 Date: Applicant: Applicant's Mailing Address: 0 07 l4b Architect or Engineer: Architect or Engineer' dr Lic. No.: BUILDING PERMIT DECLARATIONS I hereby affirm derpnalfy bf perjury that I am lice a er wsionvvf- o me in hJS�ction 7000) of Division 3 of the Business and Professionals Code, and my is nseis ntf firce and effeQ . License Clads ` \OWN -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from e Co�cto ' 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, 6r 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.& 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 Cade, for the performance f the work for which this permit is issued. d wi ma' ei workers' compensation insurance,Fquir Section 3700 0 for the performance of the work for which this permit is ss a ce o nsation insurance mer n rtY a Carrier Policy Numb r I rtif that, in the performance of thew for w h thi a it is issue &, I shat tem loy any pekol in any manner so as to become subject to the workers' co pensati n laws of Califo a ttta , 'f t should eceme su ject to the workers' compensation provisions of Section 3700 at the Labor Code, I shall fort wit ply wit a provisions. J Date App r WARNIN : FAILU E TO SECURE WORKERS' COMPE AT N E IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLA ( 100,0 ITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND A NEY' S. 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, in omni% and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission related to the work being performed, or toll wing issuance of this permit. 2. Any permit issued as a result of this application becomes nu d void if work is not commenced within 80 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I cert"havereallication and state thatthe abov tion i co I agree t mply with all ity and county ordinances and state laws relating to building consze representatives count to enter ove-mentio property inspection purposes. Datenature (Applicant or Agent): a Page 2 Application Number . . . . . 04-00006286 Date 9/13/04 Qty Unit Charge Per Extension 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 -----------------------------------------------------------------=---------- 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 3.0000 EA PLB WATER INST/ALT/REP 3.00 1:00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments POOL & SPA ONLY. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary. Charged Paid Credited ------------ - ---- ---------- Due ---------- ---------- Permit Fee Total 264.00 .00 .00 ---------- 264.00 Plan Check Total 130.80 .00 .00 130.80 Grand Total 394.80 .00 .00 394.80 VACATION POOLS & SPA, 9522 Donaldson Road �— Lucerne Valley, CA 92356 (760) 248-6045 (760) 248-2919 FAX Lic. #C-53-351673 Sales Locations Bermuda Dunes, Irvine, California City, Rialto, Lucerne Valley 1 800 999-1811 IZE m MOTOR HP I HP FILTER W p SQ FT GII TSR RA G - - .-r`-DKA ► SUCTION LINES I- RETURN LINES VACATION POOLS & SPA, 9522 Donaldson Road �— Lucerne Valley, CA 92356 (760) 248-6045 (760) 248-2919 FAX Lic. #C-53-351673 Sales Locations Bermuda Dunes, Irvine, California City, Rialto, Lucerne Valley 1 800 999-1811 IZE m MOTOR HP I HP FILTER W p SQ FT GII TSR RA G - - .-r`-DKA ► SUCTION LINES RETURN LINES SKIMMER MODEL CHECK VALV ' \VW\ _�(� GASLINE BY . FT. / \ POOL LIGHT L CLOCK ' CJS ELECTRICAL BY FT. AUTO CLEANER CHEM. FEEDER PLASTER COL R GFS �. �D DECK BY SQ. yGlp 74 U DECK TYPE STEP FT. SPA SPECS. SIZE -7RAISED LIT Z WATTS DUAL -LEVEL SEATS DAMWALL — DAMWALL TOP Le SPILLWAY SIZE X WIDE CON CTOR cannot assume responsibility for DATE SPILLWAY #JETS damag to cubs, sidewalks, driveways, cement slabs, wers, lawns, trees, fences, retaining walls, sprinkle s, telephone lines or shrubs. Name:JS When a ess is made through a neighbor's property erstood that you, the owner, have that Address:n o n neighbor's permission and assume full responsibility. / q01 CIt ..QJ! LOT#