04-6386 (RPL)Wig
. BUILDING & SAFETY DEPARTMENT
- P.O. Box 1504 (760),777:7012.
tOF n 8-4 a �taMPICO FAX (760) 777=7011
iC- 13A. 1LIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
SEF 28
.2004 BUILDING PERMIT
-CITY OF
r8Date 9/22/04
Property A. c� es. . . . . . . 48235BIGDR
APN: 6587140.-999-160 -29436 -
Application description POOL - RESIDENTIAL
Property Zoning . . . LOW DENSITY RESIDENTIAL
Appl,ica.tibn valuation. 16000
Owner. Contractor.
IVANHOE LA QUINTA COVE CALIFORNIA'POOLS & SPAS
C/OR BARRY MCCOMIC P.O. BOX 1280
:-.:'7-9`79: ; I VANHOE .AVE STE 550 COACHELLA. CA . 92236
LA JOLLA.- CA' 92037. (760) 398-9222
WCC.: STATE FUND -
WC: 0460006.1168: 01/01/05
CSLB.: 656128 10/31/04
CCC: C87C27.-C29-053.
Permit MECH POOL
Additional desc
-Permit Fee 24.00 .-Plan. 'Check Fee 6.00
Issue Date Valuation' 0
Qty. U. hit Per .%Extension
BASE .FEE 15.00:
1.00 9.0000 EA. .'MECH FURNACE <=-100K .9.00
Permit BLDG POOL PERM''
Additional desc
•Permit Fee. 171.00. Plan Check Fee -111.15
Issue Date Valuation 16000
Qty Unit Charge Per Extension
BASE . FEE 45- 00
14.00 9.0000 THOU: -BLDG 2,001--25;000 126.00
Permit ELEC'POOL PERMIT -RES
Additional desc
Permit Fee 45.00 Plan Check Fee 11.25
IssLie Date .. Valuation 0
Qty Unit Charge Per Extension
BASE FEE 15.00
P.O. BOX 1504 agwo
VOICE (760) 7.77-7012
78-495 CALLE TAMPICO .. FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
IN (760) 77777153
BUILDING & SAFETY DEPARTMENT
Application Number: a g - % 3 S �o Date: 5 7• d Li
Applicant: I Architect or Engineer
Applicant's Mailing
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 Likens is lnfull force and effect
License C License No.-
7A.
o.l G Contractor `
OWNER43UILDER DECLARATION
hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License Law for the following reason (Sea 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 (commermdng with Section 7000) of Division 3 of the Business
and Professions ) 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 oampensation, will do the work and the structure Is not Intended or offered for sale (Sea 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 I nprovement 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 (Sea 7044, Business and Professions Code: The Contradors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contras tors) Licensed pursuant to
the Contractors' State License Law.).
(, I am exempt under Sea . BA PfC. 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.
1 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 pemdt Is
due . w�or rs camgensation.insurance carrier and policy�ymbar are:
Carrier ��-I-,QtP ..t—LAXJ 1 Policy Number O 5�(_2,2/� // o B
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 1 should become subject to it* workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisAns.
Annfinanf /�yGfLNGLU'
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
1 hereby affirm under penalty of perjury that there Is a construction lending agency for the performance of the work for which this pemdt Is Issued (Sea 3097, Civ. C.).
Lenders Name
Lenders 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 whpse 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 ad or omissionrelated to the ng armed under or following Issuance of this permit Any permit issued as a result of this application becomes null and void Is commenced within 180 days from date of Issuance of such permit, or
cessation of work for 160 days will subject permit to cancellation.
1 certify that 1 have read this application and state that the above i tion Is I agree to comply with all city and county ordinances and state haws relating to building
construction and here ;uftrize representatives of this coon ter upon a boned property for inspection purposes.
DateSignature (Applicant or Agent):
Application Number . . . 04-00006386
Page 2
Date 9/22/04
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. BBQ ANSI
Z21-58-1995. 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 273.00 .00 .00
273.00
Plan Check Total 136.65 .00 .00
136.65
Grand Total 409.65 .00 .00
409.65
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NAME -- �� r RE 1DE 1 E
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J019 ADDRESS W-c�-y,
pFiO vE OFMCE RES
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VAPSOOK PAGE NO Ci
MAJL ADDR SS - -
CONSnL1CTION OFFICE PHONE N -
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REVISIONS CATS
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others.,wnie s otherwtss noted-
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