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04-5268 (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 04-0.0005268 Date 6/30'/04 Property Address .. . . . 45270 BIRCHCREST CIR -APN:' 604-412-018-27' -23995 - Application description POOL - RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL Application valuation 15000 Owner Contractor ------------------------ --------------- ---------- MCDONALD TERRY L CALIFORNIA POOLS ..& SPAS ati -c45a70- -.B. NcKEs r P.. 0.* Box 1.2 8.0 1'd6M :CA 9 255 3 COACHELLA CA .922316., Lp , u/itlT . (760) . 398-9222. WCC STATE FUND. WC:. 04600061168 01/01/05 CSLB:.• 656128 .10/31/04 CCC: C8-C27-C2.9•-05*3. ' Permit BLDG POOL PERMIT Additional desc Permit Fee 162.00 Plan Check Fee .105.30 Issue Date Valuation . . . . 15000 Qty Unit Charge Per. .Extension BASE FEE 45.00 13.00' 9:0000 THOU BLDG 2,001-25,0.00 117.00 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 <=1.0O.K 9.00 Permit . . . ELEC POOL PERMIT -RES Additional desc Permit Fee 45.00Plan Check Fee`' -11.25 Issue Date Valuat:�ion- �,��P 0' Qty. Unit Charge .Per Extension BASE FEE 15.00 -- T 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 ff P.O. BOX 1504 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: (, Date: Applicant: Applicant's Mailing Address: CIA Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS 1 hereby affirn under penalty of perjury that I am licensed ,Gods, and my Lioen LicensgrGe�nd effect / se Cias3 C.. Date T 2 LICENSED CONTRACTOR'S DECLARATION • fir vis obis of Chapter 9 (commencing with Section 7000) of Division 3 of the Business arid.. Professionals, V ER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from th ' State License Law for the knowing 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 (comr1encing 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 1, 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 tier 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 sate.). 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 Lioerse law does not apply to an owner of property who builds or Improves thereon,. and who contracts for the projects with a contrador(s) licensed pursuant to the Contractors' State license Law.). .0 I am exempt under Sec. a , 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 self4nsum 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 rkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which thus permit is issu d. workers' mpensation l ca ' r and icy number Cartier olid cy Number _ I certify that, In the performance of the work for which Ilhis mut is issued, I shall not employ any person M any.manner so as to become subject to the workers' compensation laws of Calsfoml%,. and agree Ot it Id subject to the workers! compensation provisions of Section 3700 of the Labor Code. { Shan forthwith comply with those pK*sions. /1 77 WARNING: FAILURE TO SECURE WORIlIERS'COMPENSAIldN, COVE GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1001, 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 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. 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 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 omission related to tt)e 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 w mmenced 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 int tion is co 1 gree comply with all city and county ordinances and state laws relating to building construction, and hereby authorize. representatives of this county rater upon * a e n ' vied property for inspection purposes. Date / 16�� ignature (Applicant or Agent): Page 2 Application Number . . . . . 04-00005268 Date 6/30/04 ---------------------------------------------------------------------------- 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 ----------------- ---------- Permit Fee Total 264.00 Plan Check Total 130.80 Grand Total 394.80 If Paid Credited Due ---------- ---------- ---------- .00 .00 264.00 .00 .00 130.80 .00 .00 394.80