05-0724 (RPL)E
T4hf 4 4 a,"
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-70.12
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . 05-00000724 Date 3/02/05
Property Address . . . . 81844 COUPLES CT
APN: 764-060-050- - -
Appl:ication description POOL - RESIDENTI'AL
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation 18000
Owner
-------------------------
ROLAPP
81=844 COUPLES COURT
LA:QUINTA —CA-
----------------
Permit
A
Permit
Additional
Permit Fee
Issue Date
desc .
PERMIT
Contractor
CALIFORNIA POOLS & SPAS
P.O. BOX 1.280
COACHELLA CA 92236
(760) 398-9222
WCC: SEABRIGHT INS
WC: B81050510 01/01/06
CSLB: 656.128 10/31/06
CCC,: C8 -C27 -C29-053
. . 189.00 Plan Check Fee . . 122.85
. . . . Valuation . . . . 17920
Qty Unit Charge Per Extension
BASE FEE 45.00.
16.00 9.0000 THOU BLDG 2,OD1-25,0'00 144.00
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 .
Permit Fee 3.3.00 Plan Check Fee 8.25
P.O. Boz 1.504 • " VOICE (760) 777-7012.
78-495 CALLS TAMPICO FAX (760) 777-701 I
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7.153
BUILDING & S"AFETY.DEPARTMENT
Application Number: 623-- 0 % Date:
Applicant` I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury thatl am licensed rndbyrovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code andmy Lic ig is II a and effect. �/
icense Class Licen No. SIS
Dale Contractof�
OWNER43UILDER DECLARATION,
I hereby affirm under penalty,of perjury that I am exemptfrom 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 thathe or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter9 (commencing with Section 7000) of Division 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,ownerof.the 1property, or my employees with wages as their sole compensation, will do the.work, and the structure isnot 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., 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'
StateLicense 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.)..
L) I am exempt under Sec.” , BA P.C. for this reason
Date.. Owner.
WORKERS' COMPENSA_ T_ ION DECLARATION
I hereby affirm underpenalty of perjury one of the following declarations: .
I have and will maintain a certificate of consentto,.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 d,will,maintain rkers' compensation insurance, as required bySection3700 of the Labor -Code, for the performance of the work forwhich this permit is
_AW -114 d. M orker mpensation insurance Carrie
person in any manner so as to become. subject to.the workers'
compensation laws of California, and;ag a , ' I should become subject to the workers' cornpensationprovisions of Section, 3,706 of the Labor Code, I'shall
f;17a
hhccomply with those,pr ions.
f93te A.,plicafR
WARNING: FAILURE TO SECURE WOR ERS' C--O`MPE5ftSAU1 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 37WOF 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.perfornance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lenders 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 to, and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any;acfor omission related to the wo beim rforned under or following issuance of this permit.
2. Any permit issued�as a result of this application becomes,null and void ifis 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 Cort 1 a e to comply with all city and county ordinances and state laws -relating to building
construction, and- ereby authorize representatives of this county to ant upon the entioned property for inspection purposes.
to �� Signature (Applicant or Agent):
Fee summary Charged
Permit Fee'Total 306.00
Plan Check Total 148.35
Grand Total 454.35
Paid Credited
.00 .00
.00 .00
.00 .00
Due
306.00
148.35
454.35
Page
2
Application Number . . .
. . 05-00000724 Date
3/02/05
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 . .
80
Qty Unit Charge Per
Extension
BASE FEE
15.00
-----------------------------------------------------------------------------------
Special Notes and Comments
POOL & SPA. BBQ ANSI
#Z21-58-1995..5 L.F. 41'
BLOCK WALL, CITY STANDARD.
ALARMS/BARRIERS SHALL BE :IN,PLACE PRIOR
TO PRE -PLASTER INSPECTION.
EQUIPMENT
ENCLOSURE NOT INCLUDED IN
PERMIT.
Fee summary Charged
Permit Fee'Total 306.00
Plan Check Total 148.35
Grand Total 454.35
Paid Credited
.00 .00
.00 .00
.00 .00
Due
306.00
148.35
454.35