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04-4821 (RPL)s- v A P.O. Box 1504 78-495 CALLS TAMPICO tjj1 QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 U II BUILDING PERMIT JUN 0 8 2004 U U e r . . . . . �0 4-0.0-0.0.4.821- �- -_ Date 6/08/04 P s . . 52685 AVENIDA BERMUDAS -- 773-305-021-8 -000000- Application description POOL - RESIDENTIAL v .Property Zoning . . . . . . . COVE RESIDENTIAL Application valuation 12000 . Owner ------------------------ POWER FINANCE P.O. BOX 134 LA QUINTA CA 92253 Contractor ------------------------ ADDINGTO N, DAVID 41760 HERMITAGE DRIVE INDIO CA 92201 WCC: STATE FUND WC: 2290019787 01/01/05 CSLB: 682901 12/31/05 CCC: B ---------------------------------------------------------------------------- Permit . . . . . . BLDG POOL PERMIT Additional desc Permit Fee 135.00 Plan Check Fee 87.75 Issue Date . . . Valuation. 12000 Qty Unit Charge Per Extension BASE FEE 45.00 10.00 9.0000 THOU BLDG 2,•001-25,000 90.00 ---------------------------------------------------------------------------- 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) 78-495 CALLS TAMPICO FAX (760) 77"-701 i LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-715' BUILDING & SAFETY DEPARTMENT Application Number: 0q- Date: 1!D - -0q Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: A) 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 License is i II force and effect.�1 /license Class License No.:[Q % Date ontt ctor OWNER43UILDER DECLARATION 1 hereby affirm under penalty of perjury that 1 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 signec 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 (5500).): 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 worts himself or herself or through his or her own employees. provided that the improvements are not intended or offered for sale. It. however, the building or improvement r 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 1, as owner o1 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 contraaor(s) licensed pursuant to the Contractors' State License Law.). U 1 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: 1 have and will maintain a certificate of consent to sell -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. -91 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 issyed. My worker' compensation in ce carrier d poliq number are /Cartier_!7 4 /2rf _a oIP'icy Number a I certify that, in the performance of the work for which this permit is issued. 1 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 became subject to the workers' compensation provisions of Section 3700 of the labor Code. I shall forthwith comply with those provisions. 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 (5100.000)• 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 tot which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address Sr � 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. I. 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 pernit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La OuiMa, 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 applicatiori and state that the above information is cored I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repr sentatives of this county to ente n the above-mentioned property for inspection purposes. Date �>� ignature (Applicant or Agent): Page 2 Application Number . . . . . 04-00004821 Date 6/08/04 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc 2 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 237.00 .00 .00 ---------- 237.00 Plan Check Total 113.25 .00 .00 113.25 Grand Total 350.25 .00 .00 350.25 Saia- �R mam' 's�`VQRL p= � 3JWM'M&Od 61 //-- 4 J � In/I SSW ,,u y V /iN3wIw.13a 67PJom 011ew V1NIry Vl d0 Allo wowd n V093a1��o dlol X xvm3n�o �! 0 0G ' llV role W -H H .0-.E 1H913tQ'Sel Hf I - 1 j H Arm 1HV13H .E•.0 Hl%N3l.ml.L Y N ..41E M3134R+14Q m N JF1�VdS �3l .m97R+lA�Cl�d $ I' --1 �NV'1 rydOPldTDl1V9651 '•• U,1 u 0 D 0 m 6-Z IlJn7'L% I U'i`i"d • 1332116 3H1 IJOY.d3.101�31ANV'31eI61A �`� sa3e�.nN 133a1s a31VNlunly �. 9 � ti b I I �t1 �d5ls�q� A I •I � � I I II I o� -------------------- L P- wlu 3tAt�rI89TC -.. - Vd .9x.' I Twm >pol9 OVd nnlH .0 .5 "•GI .ox.v _ I ! 37N3d Clow HhIH .0-.5 Fn 13�v2�o FT � T T N 13TV 1 �•� LI ...L �•.� 4iI V 1 I I ®�z 8 I T I I , E Nv'H1 6631 ON ,9x. 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