04-6653 (RPL)W
T44f. 4 4 Q"
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . .
. . r04-00006653 Date
10/06/04
Property Address . . . .
. . 79655 BAYA_
APN:
772=330-056- - -
Application description
POOL - RESIDENTIAL
Property Zoning_. . . . .
. . LOW DENSITY RESIDENTIAL
Application valuation . .
. . 0
Owner
Contractor
------------------------
CURRAN WILLIAM Q
------------------------
TOPMAN BUILDERS
P 0 BOX 1400
P.O. BOX 10202
LA QUINTA CA 92253
- —PALM DESERT
CA 92255
-
_ -
(760) 772-7296
'IWCC: VIRGINIA SURETY
WC: 00500019402
01/01/05
,CSLB: 455121
11/30/05
i�CCC: B -C29
------------------------------
ar -----------------------------
Permit BLDG
POOL;°=°PERMIT`
Additional desc . . J___
�-
Permit Fee 258.50
Plan Check Fee
168.03
Issue Date
Valuation . . . .
26000
Qty Unit Charge Per
Extension
BASE FEE
252.00
1.00 6.5000 THOU
BLDG 25,001-50,000
6.50
----------------------------------------------------------------------------
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 . . . . . . 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
ELEC PRIVATE SWIMMING POOL
30.00
P.O. Box 1504�� VOICE (760) 777-7012
Titf
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0't- 3 I Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
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 Licen i�s,��'DD II force and effect.
/Xicense Class �7 ce No.
ate IICI��Contracto
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that am exe t 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 const t, alter, prove, 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 visions 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 eicemption. 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 Cade: 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. , BA P.C. for this reason
Date Owner.
WORKERS' COMPENSATION DECLARATION
1 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
sued. MY coon ers^compensation i nce carrier a and�oticy�umber are:
�rrier V�14�,\NIP' �UIGf�C`� olicyNumber 688 9 ig4cs4csa
_ ('certify that, in the perfbrmancd'of the wo),4
rhic�is permit is issued, I shall riot employ any person in any manner so as to become subject to the workers'
compensation laws of California, and a at, i 1 hould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall
forthwith comply with those provisions. n
WARNING: FAILURE TO SECURE W KERS' COM ENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED TH AND LLARS ($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 11 0C
Lender's Address ti I
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 Quinta, 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 info 'on is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and h eby authorize representatives of this county to ter oIthe ove-mentioned property for inspection purposes.
ate '�
Signature or Age ):
Page 2
Application Number . . . . . 04-00006653
Date 10/06/04
----------------------------------------------------------------------------
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. ALARMS/BARRIERS SHALL BE IN
PLACE AT -PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited
---------------------------
Due
--------------------
Permit Fee Total 360.50 .00 .00
----------
360.50
Plan Check Total 193.53 .00 .00
193.53
Grand Total 554.03 .00 .00
554.03
m
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