04-6654 (RPL)a
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 . . . .04-00006654 Date 10/06/04
Property Address . . . . 80944-BELLERIVE }
APN: 775-350-005- - -
Application description . . . POOL --RESIDENTIAL
Property Zoning . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 20000
Owner Contractor
PENNY ZENKER ALPINE SERVICES
80944 BELLERIVE P.O. BOX 4687
LA QUINTA CA 92253 PALM DESERT CA 92261
WCC: STATE FUND
WC: 229002323604 01/01/05
CSLB: 786324 1.0/31/04
CCC: C53
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Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Fee . . . . 207.00 Plan Check Fee 134.55
Issue Date Valuation . . . . 20000
Qty Unit Charge Per Extension
BASE FEE _%(45.00
18.00 9.0000 THOU BLDG 2,,001-25,000 -162'. 00
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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
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Permit . . . . . ELEC POOL PERMIT -RES
Additional desc t°_
Permit Fee 45.00 Plan Check Fee 11.25
Issue Date Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE Q 15.00
1.00 30.0000 EA ELEC PRIVATE SWIM ING POOL 30.00
.,.00T- 13 2004
P.O. BOX 15044 4 �� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0 Date:
Applicant: II Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
P3 1A
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
/ ` , and my License is in full force and effect.
,cense Class C- -5 3 ^,cense No. ?�ji3d k'
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 Coda: 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 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. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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
issued. workers' compensation ,n nce carrier and otic n r�be�
arrier STRT6r �c..�( -licy Number � �U of os
I certify that, in the performance of the work for which this permit is issued, I 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.
__BSte 1/" f 3 /b LC,cant .
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.).
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, 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 information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives o: -'a
s county n the above-mentioned property for inspection purposes.
ate O i O S� i nature (Applicant or: 7
Page 2
Application Number . . . . . 04-00006654 Date 10/06/04
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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
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Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED. BBQ BY
- SEPARATE PERMIT
Fee summary Charged
----------------- ----------
Permit Fee.Total 309.00
Plan Check Total 160.05
Grand Total 469.05
Paid Credited Due
---------- ---------- ----------
.00 .00 309.00
.00, .00 160.05
.00 .00 469.05
PREPARED 3/14/05,
15:35:08
INSPECTION HISTORY REPORT
PAGE 1
PROGRAM
BP521L
0/00/00 THRU 0/00/00
CITY OF
LA
QUINTA
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APPLICATION
PROPERTY ADDRESS
APN
-----------------------------------
Alternate ID
- -
STRUCTR
------------------------------------------------------------------------------------------------------------------------------------
PERMIT
INSPECTION
RESULT DATE/STATUS
INSPECTOR
04 00006654
80944 BELLERIVE
775-350-005-
- -
000
000
M001
00
MECH POOL
499
0001 MECHANICAL FINAL
2/28/05
APPROVED
GH
000
000
P001
00
BLDG POOL PERMIT
170
0001 PRE-GUNITE
10/22/04
APPROVED
ST
000
000
P001
00
BLDG POOL PERMIT
175
0001 PRE -PLASTER
12/20/04
DISAPPROVED
ST
000
000
P001
00
BLDG POOL PERMIT
175
0002 PRE -PLASTER
12/30/04
APPROVED
GH
000
000
P001
00
BLDG POOL PERMIT
199
0001 FINAL
2/28/05
APPROVED
GH
000
000
P002
00
ELEC POOL PERMIT -RES
305
0001 UNDERGROUND ELECTRICAL
10/22/04
APPROVED
ST
000
000
P002
00
ELEC POOL PERMIT -RES
399
0001 ELECTRICAL FINAL
2/28/05
APPROVED
GH'
000
000
P003
00
PLUMBING POOL
200
0001 UNDERGROUND PLUMBING
10/22/04
APPROVED
ST
000
000
P003
00
PLUMBING POOL
205
0001 UNDERGROUND GAS
10/22/04
APPROVED
ST
000
000
P003
00
PLUMBING POOL
299
0001 PLUMBING FINAL
2/28/05
APPROVED
GH
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