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05-0607 (RPL)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 . . . . �_ 5 0-0.0.0.0.6.0_7' Date 2/16/05 Property Address . . . v,81859 PRISM DR APN: 764=270-999-65 300232 - Application description POOL - RESIDENTIAL Property Zoning . . . . MEDIUM HIGH DENSITY RES Application valuation . . . . 12000 Owner ntractor ---------------------- - ----------------_----- SANDRA MOSLEY ER " 81-859 PRISM DRIVE D 1� LA QUINTA 22.0 - ---�------- =------G�r�----------------------------------- Permit . . . . P BI6 L INV FEE Additional desc Permit Fee` 66.00 Plan Check Fee 8.25 Issue Date Valuation 0 Expiration Date 8/16/05 Qty Unit Charge Per Extension BASE FEE 30.00 2, 00 12.0000EA IPLB FIXTURE' 24.00 1.00 6.0000 EA PLB WATER INST/ALT/REP 6.00 1.00 6.0000 EA PLB GAS PIPE 1-4 OUTLETS 6.00 --------------------.-------------------------------------------------------- Permit . . . . . . MECH POOL Additional desc Permit Fee 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation 0 Expiration Date 8/16"/05 Qty Unit Charge Per Extension BASE FEE 15.00 "1.00 9.0000 EA MECH FURNACE <=100K 9.0'0 ---------------------------------------------------------------------------- Permit . . BLDG POOL.PERMIT INV FEE Additional desc Permit Fee . . 270.00 Plan Check Fee '87.75 Issue Date Valuation 12000 Expiration Date 8/16/05 Qty Unit Charge Per Extension BASE FEE 90.00 10.00 18.0000 THOU BLDG 2,001-25,000 180.00 Permit . . . . . . ELEC POOL PERMIT -RES Additional desc P.O. Box 1504 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: Architect or Engineer: 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 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).): 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 (;ompletion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). 1, 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.). L) I am exempt under Sec. , BA P.C. for this reason V-16'atk e' WORKERS' CO PENSATION 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 issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number �C 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. v ^ r ate t Applica. / VV 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 Lenders 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. I agree to comply with all city and county ordinances and state laws relating to building ZDate ti n, an -hereby authorize representatives of this coun�tonteru,,pon;he above-mentioned property for inspection purposes. �Zc�6S Signature (Applicant or Agent):V l Page 2 Application Number . . . . . 05-00000607 Date 2/16/05 Permit Fee . . 45.00 Plan Check Fee . . 11.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 8/16/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 ----------------------------------------I------------------------------------ Special Notes and Comments POOL & SPA. FIREPIT #C1-039. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. INVESTIGATION FEE ASESSED PER 1997 UNIFORM ADMINISTRATIVE CODE 304.5 FOR WORK BEGUN WITHOUT BUILDING PERMIT. Fee summary Charged Paid Credited ----------------- Due ------------------------------ Permit Fee Total 405.00 .00 ---------- .00 405.00 Plan Check Total 113.25 .00 .00 113.25 Grand Total 518.25 .00 .00 518.25 , i1 � I j t i► ► I ' 1 I l I L I I 1 ,8A� J s l t it I � I i - I , 1 4 I I 1 E _ I 1 I , -- ' I I I k f � , I R , NL—1�Nos - r I t i 1 ►OWN I I i I I I k I , 1 - I r I41 +j C��� br tlit��,, }:1, r' `a����ii��►� ��,�. 1 �' �}+•ar ;� � � I ( I tlr t&AI I 1 e I 1A 4 —_ _- I_ 100, ''!! I- ��-- a---- - - --- -- — — ,� I ' I LA - ' �tl '`VA Al ri dp, 1 -- ' � I y ! try 1 imp 1 IL I- � I i 1 ' I� . ._..._,.,I 1 1 I I I pc k61__ ( k ' I I , I L - --- - - - _- 1 ► r-- - - - -- -I -- - - - I , 1 I t � I I� �► � _— - r __iii � I I 4 I ��C�1P —0 os y - cD:�, t I � �40ort s '� I � � � - r ► t ' k I 14A *To 0 4 N4 l l i l CITY OF LA QUINTA BUILDING & SAFETY DEPT. IF / _PWW,-� , .,,i C - APPROVED FOR CONSTRUCTION ©A t� oBY Ci4 CITY OF LA QUINTA SUB -CONTRACTOR LIST,. U '4f IS111 PERMIT-NUMBE*R, QS- �o'Q Z' - OWNER - SWAIDeA /tlO Z16�_Y DER JOB ADDRESS & -work This form shall be Posted on the'job With the Building Inspection Card aVail times in a conspicuous place. Only persons appearing on kth)or their employees are authorized'to on this iob. 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. %)n t-iie­ is not an accep-EaDle respunbt:- ........ ... ......... . . . ........................ ...... ....... .... . >>>.. UUr—Y, L_ C .... .. ... . . ... ......... .... .. .......... .... .. .. - ­ ............ . .... .. ... . .. ... ..................... ­-­................... ... .. ... .... ......... : - ... ... : . ..... ....................... ...... ................ .. ... .......... .: . .6n ...... ... t ..... ... ........ , , " ,, :::: .. . ... . . . . *'* ,,, ,,, , "' ... ...■ . :1 ft:.ft UE9i ___ ­ - ­ , -, "I ��! *.*.*'. ". Company Name Classification Li6ense Number' ExP. bate •.. Carrier Name Policy. umber Exp.'Date License Number Exp. Date X., .............. ... .... ........... . . ........... .. I -(e.g. A, B; C-81 •(xxxxxx) I Nx/Wx�) .(e.g.. State Fund, CalComp) F ormat Varies) x (x /X)i/xx) (xxxx) (xx/xx/xx) : . .......... ....... . . . . . ..... .. ... . ... .. . ................ P FI . . . . . . . . . . . s tM .. ........ ........... ................. .............. :M ............. .............. Mal N: I ............. ..... ....... ........... NT DA:S� . :3i:i: I INTI: ............ ...... - .C ........................... .. .. ..... .... . Vv IM .... ....... .............................. *�.-T.-S*".***T..'6 ............ ............ ......... • cIt-11 �/o ......... MDS' AP I9 n 6Cel r7 l