05-1193 (RPL)n
Tdf 4.4 Q#AZ
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA. 92253
BUILDING PERMIT
Number . . . : .
dress . . . . . .
description .
Property Zoning . . . . .
Application valuation . .
Owner
TOLL CA V
C/O KEVIN D DUERMIT
8901 E MOUNTAIN VIEW 200
SCOTTSDALE AZ 85258
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
05=00001193' Date 3/30/05
80345 CAMARILLO WY
772-250-997-125 -31349 -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
18000
Contractor
CALIFORNIA POOLS & SPAS
P.O. BOX 1280
COACHELLA. CA 92236
(760) 398-9222
WCC: SEABRIGHT
INS
WC: BB1050510
01/01/06
CSLB: 656128
10/31/06
C8 C27 C29
C53-
53---CCC:
-----------------------------=-------------------------------------------
--------------------------------
Permit .
Permit
. . . . .
-------------------------------------------
BLDG POOL PERMIT
Additional
desc
Permit Fee
. . . .
189.00
Plan Check Fee
122.85
Issue Date
. . . .
Valuation . . .
. 17783
Qty Unit Charge.
Per
Extension
BASE
FEE
45.00
16.00
9.0000
THOU BLDG
2,001-25,000
144.00
----------------------------------------------------------------------------
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
----------------------------------------------------------------------------
Permit .
. . . . .
PLUMBING
Additional
desc
P.O. Box 1504• �� VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253. 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: .� 3 Date: U T� Os --OT
Applicant:
Applicant's Mailing Address:
P,4 cTo /2
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
19-
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions o Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
�e, and m Licensf i rce and effect. / (�
icense Class C. ens No. �SIQ f Z
A- . /
alP'te -/ /� �S_ Contractor
:::�
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 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 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 1, as owner of the property,'am exclusively contracting with licensedcontractors 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:
_ 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 maintain workers' compensation insurance, s required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
i M wo�k rs' compensation insurance carrier d pgliyy/I nyyQ�Q��r re
arrier :5 yZ p Policy Number C� 70liLJ� tp%
_ 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, i sho become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
`fort`hwith comply with those provisions.
-Date ✓ ! S Applicant/
WARNING: FAILURE TO SECURE WORKERS OMPENS'ATION-bVERAGE 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 ect. gree to comply with all city and county ordinances and state laws relating to building
�c/o/ns/truction,Cnd �Sereby authorize representatives of this county to r upo th bov -mentioned property for inspection purposes.
(/Date v v� Signature (Applicant or Ageg2
1E
R
Page 2
Application Number . . . . . 05-00001193
Date 3/30/05
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
3-• Additional desc
Permit Fee . . . . 15.00 Plan Check
Fee
.00
Issue Date . . . Valuation
217
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL & SPA. 10 L.F. 5' BLOCK WALL, CITY
STANDARD. ALARMS/BARRIERS SHALL BE IN
PLACE PRIOR TO PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED IN•
PERMIT.
Fee summary Charged Paid Credited
-----------------
Due
------------------------------
' Permit Fee Total 306.00 .00
.00
----------
306.00
Plan Check Total 148.35 .00
.00
148.35
Grand Total 454.35 .00
.00
454.35
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- — - - - [-r others, L n Lfess t:Terwise noted.
_