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04-5421 (RPL)Tdf .4 4 a" P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760),777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . -,04-0000542-1 Date 7/12/04 Property Address . . ... . . 79360 BROOKVILLE APN: 772-040-019- - - Application description . . . POOL - RESIDENTIAL Property Zoning . . . . LOW DENSITY RESIDENTIAL Application valuation 20000 Owner ----------------------- 7 - LA QUINTA ORCHARDS PARTNERS C/O LA QUINTA-ORCHARD PARTNERS P 0 BOX 1716 LA QUINTA A -9-a2 5 3 SEP 9a253 SEP Q 3 2004. --1--- CTM LAQUIrJT6� ---------------. R%%_Ai9rrG_"T.--- Permit BLDG POOL PERMIT Additional desc Permit Fee . . . . 207.00 Issue Date L . Contractor ------------------------ CALIFORNIA POOLS & SPAS :P.O. BOX 1280 COACHELLA CA 92236 1(760) 398-9222 CC: STATE FUND C: 04600061168 01/01/05 SLB: 656128 10/31/04 1CC:-----C8_C27_C29_C53----- --- ----- Plan Check Fee 134.55 Valuation 19760 Qty Unit Charge Per Extension BASE FEE 45.00 18.00 9.0000 THOU BLDG 2,001-25,000 162.00 -------------------------------------------------------------- ------------- 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 1.00.1 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 P.O. Box 1504 • �� 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Ot VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: L /"Oq - - Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under row ' ns of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Liceryr�ssgg is m Su �rcaand effect. .,--license Class C:—� ce e No. t✓/ Z , cDate Co or OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from Te 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 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 hoes 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 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 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 mainteIp workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is work compenurance came ,oliyr e: Crer 5-�s=4lf m Policy Number t16 _ I certify that, in the perforhance of the work for whic this 221mit 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, i I should come subject to the workers' compensation provisions of Section 3700 of the Labor Code, l shall forthwith comply with those provisions. �. CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAARRSS(($1 dNING: FAILURE TO SECURE WORKARS' pCOV) RAAADDD T ON TO HE OST OF COMPENSATION, IS UNLAWFUL, AND SHALL SUBJECT ANPAMAG S SCRIMINAL PROVI ED FOR NES AND TO CI 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 /� 1 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, indemnity and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work i erfomted under or following issuance of this permit 2. Any permit issued as a result of this application becomes null and void if ork is n 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 rr I ag to comply with all city and county ordinances and state laws relating to building construc9tion, nd h reby authorize representatives of this2)01U0 enter n bovementioned property for inspection purposes. Date l v Sm nature (A licant or A 9 PP 99 Page 2 Application Number 04-00005421 Date 7/12/04 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 ---------------------------------------------------------------------------- Permit . . . . . . WALL/FENCE PERMIT Additional desc Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 240 Qty- Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments POOL/SPA,WATER FEATURE, 15 L.F. 4' BLOCK WALL, CITY STANDARD ALARMS/BARRIERS SHALL BE IN-PLACE AT PRE -PLASTER INSPECTION. Fee summary Charged ----------------- ---------- Permit Fee Total 324.00 Plan Check Total 160.05 Grand Total 484.05 Paid Credited Due ---------- -=-------- ---------- .00 .00 324.00 .00 .00 160.05 .00 .00 484.05