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04-4901 (RPL)T44f 4 4Qabra BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . '".0.4;,0-0004=9-0-1- Date 6/11/04 Property Address . . . . . .. 80664 BELLERIVE APN: 775-360-008-18 -28961 - Application description . . . POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . 19000 Owner CRV LA QUINTA 70 LP C/O CAPSTONE ADVISORS 9255 TOWNE CENTER DR 520 SAN DIEGO CA 92121 Contractor CALIFORNIA POOLS & SPAS P.O. BOX 1280 COACHELLA CA 92236 (760) 398-9222 WCC: STATE FUND WC: 04600061168 01/01/05 CSLB: 65.6128 10/31/04 CCC: C8 -C27 -C29-053 --------------------------------- ------------------------------------------ Permit . . . . . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 198.00 Plan Check Fee 128.70 Issue Date . . . . Valuation 19000 Qty Unit Charge Per Extension BASE ."FEE 45.00 17.00 9.0000 THOU BLDG 2,001-25,000 153.0.0 ---------------------------------------------------------------------------- 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 1.0.0 9.0000 EA MECH FURNACE <=100K 9.00 ------------------------------------------------------7--------------------- Permit . . . . . ELEC POOL PERMIT -RES Additional desc Permit Fee . . . . 45.00 Plan Check Fe..e 11.25 Issue Date . . . . .. _ V n 0 A u Qty Unit Charge Per D Extension BASE FE JUL 6 2004 15.00 F OhA QUit�?A OI?Y _ P.O. BOX 1504• �� VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 04- Date: Applicant: Applicant's Mailing Address: Aid ('�r LA/ 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 (Comma ci with Section 7000) of Division 3 of the Business and Professionals Code, and my LicenA is in II rce and effect. / iCicense Class (" cense No.zz [ a _ Date ntractor OWNER43UILDER 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 safe. 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. , BA 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 Code, for the performance of the work for which this permit is issued. I have and will maintain wo ars' compensati n insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issu d. orkers` co pensatio ' rance carrier a"num/Carrier Policy NumberI certi y that, in the performance of the work for which hisII not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those proyoti ns. .-- Date — //,� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COV RA E IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), 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 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, a s d, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being p o ed under o ollowing issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is t mmenced with)ri 180 days Vom 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 d state that the above info ation is correct. a e o comply with II city and county ordinances and state laws relating io building construction,and he /bb authorizer resentatives of this county to er upon the ab a an6 ned grope for inspection purposes. ate 6 u ( Signature (Applicant or Agent): Za Page 2 Application Number . . . . . 04-00004901 Date 6/11/04 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, BBQ(ANSI Z21-58-1995) ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee summary Charged Paid Credited ----------------- ---------- Due --- ------ ---------- Permit Fee Total 300.00 .00 .00 ---------- 300,.00 Plan Check Total 154.20 .00 .00 154.20 Grand Total 454.20 .00 .00 454.20 GAP, '��CN r- ) LPeqo-' AIM , ^NP T e-� ISTONF- LL 'e t 2— MEW"- rt T0�04NK(F r� --- p L T- A -- FFA I't-,EV PAN U e A M ^J + 4 'j'' W IT h �' M F f f`# I f>f`7 j!xVtA,-VPrr-r- . OF- Cove-t "-fzk H ; 4CALLp-k fE. OF:1116IMOTA '? 'rEmk'rMR - FAA SgEC T[ON S Ti LE 71 Dm WAS 70TM W`M LW -- V= SPA A' -�.. 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