05-0498 (RPL)jet .
T4hf 4 4Q�dArw
1504
ELLE TAMPICO
A, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT .
ption .
Property Zoning . . . . .
Application valuation . .
05-00000498 Date 2/09/05
79710 CORTE NUEVO
609-580-009- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
28000
Owner
Contractor
MR. & MRS. VOGEL
CASA VERDE LANDSCAPE
MAINT COR
79710 CORTE NUEVO
78341 DARBY ROAD
LA QUINTA
CA 92253
BERMUDA DUNES
CA 92201-0.
(760) 320-8755
WCC: GRANITE
WC: 9549987
09/05/05
CSLB: 624647
08/31/06
CCC: C-27
-----------------------------------------------------
Permit . . . . . .
-----------------------
BLDG POOL PERMIT
Additional desc
Permit Fee . . .
271.50
Plan Check Fee
176.48
Issue Date . . . .
Valuation . . . .
28000
Qty Unit Charge
Per
Extension
BASE
FEE
252.00
3.00 6.5000
THOU BLDG
25,001-50,000
19.50
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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
`
Permit Fee . . . .
33.00
Plan Check Fee
8.25
P.O. Box 1504�� VOICE (760) 777-7012
TdAt
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
LID' IVTR�C T02
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 License is in full force and effect.
License Classt ` �i License No.
,,Date,1y IVS Contractor/6sa UF�Jc C.0'al CA -Pr
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 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 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, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/r issye�dnMwo�kers' compensation insurance Carrie nd
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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
ate al S Applicant CAP 0 E (,i4- j)SC"C
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
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 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 correct ee to comply with all city and county ordinances and state laws relating to building
construction, and -hereby authorize representatives of this county to enter upon th ove-r ntioned property for inspection purposes.
tf7a a `� Signature (Applicant or Agent):
Application Number . . . ..
Issue Date . . . .
Page 2
05-00000498 Date 2/09/05
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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Special Notes and Comments
POOL & SPA. ALARMS/BARRIERS SHALL BE IN
PLACE PRIOR TO INSPECTION. EQUIPMENT
ENCLOSURE NOT INCLUDED IN PERMIT.
Fee summary Charged Paid
-----------------
Credited
Due
------------------------------
Permit Fee Total 373.50 .00
----------
.00
373.50
Plan Check Total 201.98 .00
.00
201.98
Grand Total 575.48 .00
.00
575.48
'SPECIFICATIONS
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CA.LIC.# 585287
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ACL CONSULTANT
A DIVISION OF CASA VERDE LANDSCAPE
78-341 DARBY RD BERMUDA DUNES,CA.92203
Busl (760) 880-2203 Fax, (760) 360-6725 Llcense# 624647
CONSTRUCTION AUTHORIZATION,
PI�_�N,� _VE
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