05-1264 (RPL)Tiht 4 4 a"
�MPICO
FORNIA 92253
BUILDING PERMIT
APN:
Application 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
05-00001264 Date 4/05/05
80405 CAMARILLO WY
772-250-997-119 -31349 -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
19000
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
CCC: C8' C2 7 C29
C53
----------------------------------------------------------------------------
Permit . . . .
. .
BLDG POOL PERMIT
Additional desc
. .
Permit Fee . .
. .
198.00
Plan Check Fee
128.70
Issue Date . .
. .
Valuation . . .
. 18783
Qty Unit
Charge
Per
Extension
BASE
FEE
45.00
17.00
----------------------------------------------------------------------------
9.0000
THOU BLDG
2,001-25,000
153.00
Permit . . . .
. .
MECH POOL
Additional desc
Permit Fee . .
. .
24.00
Plan Check Fee..
6.00
Issue Date . .
. .
Valuation . . .
. 0
Qty Unit
Charge
Per
Ext.ension
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
. .
Air
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: Qom. �_2 & �4 Date:
Applicant:
Applicant's Mailing Address:
0n6y'/eA GTOk
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I eby affirm under penalty of perjury that I am licensed under provision s_pf Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
ode, and my Lic is�a�Eu�Jorce and effect. n
License Class _ tJ_7 ^ rkense No. � >J
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 burderrof 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 a d 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
� � isoy;worker ompensation insurance carne r^g i u yea( / / /
12arrier ( 41 %fin Policy Number ' [�� /n (��61 (0
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ aperson in any manner so as to become subject to the workers'
compensation laws of California, and agree t I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Applicant
WARNING: FAILURE TO SECURE WOR RS' 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
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 Ouinta, 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 andAbve-
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 information comply with all city and county ordinances and state laws relating to building
construction, and here y authorize representatives of this county toe uped property for inspection purposes.
Date / ��; Sin cure(Applicant r Agit)
Page
2
Application Number . . . . . 05-00001264 Date
4/05/05
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
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Permit . . . . . . WALL/FENCE PERMIT
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. BBQ & FIREPIT ANSI
Z21-58-1995CGA. 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
-----------------
Permit Fee Total
Plan Check Total
Grand Total
Charged Paid
315.00 .00
154.20 .001
469.20 .00
Credited Due
.00 315.00
.00 154.20
.00 469.20
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4V OR TQ; (T) 6ETERMIC THE AP-MV LATE ElydAWH U POIX %-P 93A Ai LAWYlT ON DAY OF QOCAVATIM
(2) TA,}E N0110E iNAT PDX No EQ{JIPUMT LOCATILM ARE 9LRLUT TO AC -TARCE IT
WCAL gapm OEPA4R7west m TwL t)p ISVUAA c CF PERkor
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(A) AI;}tEE THAT CkJFCRffiA PODLSr in NOT At"SIW FM UNKPOKAJIM )DtaTMPL C1R OMC-IS
AdAU ANY Q.13" TU {JJRHB, I$AFWALKE. MVEWAM LkWND. OR Utfl R"1TNS fN THE ACdFss AFF-4
(s) Sa THAT ALL FENG�ATa�4 AND GATE 1XIOG MUM LOCH 006E$ FOA A RoaL Fla FT
P To PRg3js ri 1 SPECTI N
(6) FILL P60L &VENA Y AMk PI-A5".. (F;xUOW WSMC7141,3 -- DO NOT USE RlfSM--R HOSE)
(71 THE NOVI 7HArT M DRA4iWC IS 1Tlt 3IXi T+' CF GALLIFUWA PDOLS AND THAT Wy
USE WITHOUT RRITEEN PU411ISSIDH OF CALIFORW POOLS, WC, IS PFrT Ht"TEr} BY LAYI.
{jM4F APPROVES. 4'LhN. POOL ANQ EQaPW -KT LCIUATIONS AND HAS HEAD THE K291VNSaLJlE5 AMD NGTCE5 A6GVF
910NA7URf{$) MITE
SW MMIN POOL PLAN FOR:
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NAME mmKER RESIDENCE
,;GB ADDRESS t E f' ':f v,F3^j . .CITY -�,A lQdEms ,
I HbNE OFFICE RES
L_QT S TRACT #SAGE Bf} K -
MAP BOOK PAGE NO.
CITY
NAIL ADDRESS
_
CONSTRUCTfOLN OFFICE PHONE NO.
SALE
i)ATE
2,3
DRAWN BY
fi LO BY
_
CHECKED By
1TY OF LA QUINT
I
2
BUILDING & SA4�W D
APPROVED
FOR CONSTRUCTION
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RIGNATURE
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