04-4424 (RPL)TA�F �Q�rw
W�� Y BUILDING & SAFETY DEPARTMENT
.0. Box 1504
(760).777-7012
8-495 CALLE TAMPICO
FAX
(760) 777-7011
A QUINTA, CALIFORNIA 92253
INSPECTION REQUESTS
(760) 777-7153
MAY 21 2 004
BUILDING
PERMIT.
CITY Of l A QU11KN,
Application Number --0-4---0*-0-0'--04f-4---2--4
Date 5/19/04
Property Address .,---6-034-7--PRICKLY
PEAR LN
APN: 764-270-999-57
-300232-
Application description . . . POOL
- RESIDENTIAL
Property Zoning . . . . . . . MEDIUM
HIGH DENSITY RES
Application valuation
15000
.Owner
Contractor
------------------------
ROBERT GUTTMAN
------------------------
OWNER
60347 PRICKLY PEAR LN
LA QUINTA CA 92253
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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
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Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit. Fee . . . . 162.00
Plan Check Fee
105.30
Issue Date
Valuation . .
. . 15.000
Qty Unit Charge Per
Extension
BASE
FEE
45.00
13.00, 9.0000 THOU BLDG
2,001-25,000
117.00
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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 POOL.
30.00
---------- = ------------------------------------------------------------------
.Permit . . . . . . PLUMBING
Additional desc'.
Permit Fee- 27.00
Plan Check Fee
6.75
P.O. Box 1504
Y
78-495 CALLS TAMPICO VOICE (760) 777-7012FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: JDate:
Applicant:
Applicant's Mailing Address:. Z�
Architect or Engineer:
Architect or Engineer's
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 1, as owner of the property, or my employees with wages as their stile 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 contractors) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date J Z G 1 GOwner �sjaaS� iC:�s1�s++c ✓L�
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
issued. My workers' compensation insurance carrier and policy number are:
Cartier Policy Number
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.
Date Applicant
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.).
Lenders Name
Lenders Address
APPLICANT
IMPORTANT Application is hereby made to the Director of Buildin and SaACKNOWLEDGEMENT
o Ato
1. Each person upon whose behalf this application.is made, each person at Permit
1e request and efor whose ose benefit works
rk performed under or pus set forth on this rsuant 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 Quinta, 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
construction, and hereby authorize representatives of this county to enter upon the
`above-mentioned property for inspection purposes.
nt or Agent):
Date r Signature (Applica�� f�4:�t
Page 2
Application
Number . . . .... 04-00004424
Date 5/19/04
Issue Date
. . . . Valuation
0
Qty Unit
Charge Per
Extension.
BASE FEE
15.00
1.00
6.0000 EA PLB FIXTURE
6.00
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 ONLY. ALARMS BARRIERS SHALL BE IN
PLACE PRIOR
TO PREPLASTER INSPECTION.
Fee summary
-----------------
Charged Paid Credited
Due
Permit Fee
------------------------------
Total 258.00 .0.0 .00
----------
258.00
Plan Check
Total 129.30 .00 .00
129.30
Grand Total
.38'7.30 .00 .00
.387.30
X
A RE -INSPECTION FEE OF $30
WILL BECHARGED IfTHE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED !"
INSPECTION.
NO EXCEPTIONS!
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
W
FO NSTRUCTIO
N_
i9f��5S DATE BY