04-3491 (RPL)a
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BUILDING & SAFETY. DEPARTMENT
P.O. BOX 1504 (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . C--0_4-0.0'0.0.34.91 r \' Date 4/15/04
Property Address . . . . . . 79419 PASEO DEL REY
APN:. 604-440-005-5 -27519 =
Application description .POOL - RESIDENTIAL
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation 30000 �.
Owner Contractor
------------------------ ---------------------
DARASCAVAGE BRYAN OWNER/BUILDER
79-419 PASEO DEL REY
LA QUINTA
LA QUINTA CA 92253-
(760) 345-4677 7_7
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. Permit . . . . . . MECH POOL
Additional desc
Permit Fee 24..00 Plan Check Fee 8.25
Issue Date . . . . Valuation . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 9.0000 EA MECH FURNANCE <=100K 9.00
-
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Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Fee . . . . 284.50 Plan Check Fee 184.93
Issue Date . . . Valuation . . . . 30000
Qty Unit Charge Per Extension
BASE FEE 252..00
5.00 6.5000 THOU BLDG 25,001-50,000 32.50
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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 PCOL 30.00
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Permit . . . PLUMBING
Additional desc
Permit Fee 33.00 'Plan Check Fee 8.25
R
P.O. BOC 1504
78-495 CALLS TAMPICO VOICE (760) 777-7012
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 3,/9 I Date:
Applicant:
• .. • ..U,
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
LSUILUING 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 Class License No.
Date 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).):
(--) 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.).
AI, 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 O lE o 00 y Owner
�KERS-COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self4nsure 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
issued. My workers' compensation insurance carrier and policy number are:
Carrier i Policy Number
�._ 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, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall
f .t �� y nforthwith comply with those provisions.
DateSl7r e 19 L/_ Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO ERAGE 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 AAA i
Lenders Address I
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 Le Quinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this pemut.
2. Any permit Issued as a result of this application becomes null and void if work is not commenced within 160 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. I agree 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 the above- mentioned property for inspection purposes.
Date_ Signature (Applicant or Agent):
Page 2
Application
Number
04-000,03491
Date 4/15/04
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 OUTLET
3.00
Special Notes
and Comments
--------------------
POOL AND SPA
ONLY. ALARMS BARRIERS SHALL
BE IN PLACE
PRIOR TO PREPLASTER
INSPECTION.
Fee summary
Charged
Paid Creditec
Due
Permit Fee
Total 386.50
.00 C0
386.50
Plan Check
Total 212.68
.00 C0
212.68
Grand Total
' 599.18
.00 :C0
599.18
owns
CITY. OF LA QUINTA •SUB -CONTRACTOR LIST
JbB ADDRESS��-�dl� i��iS�,o lam(_' l��y
PERMIT NUMBER __ OWNER BK4 ��F��Sc�ai/�a�a� BUILDER
'
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized
to work -
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the
voidance
of building permit. For each applicable trade, all information requested below must be completed by
applicant. "On File" is not an acceptable response.
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