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04-6313 (RPL)tr, � � ps BUILDING & SAFETY DEPARTMENT 15Q�4 (760).7774012. pF.� 78-495 CA[ LSE TAMPICO FAX (760) 777-7011 L. QurNT��&LIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT App ication Number . . 04-00006313 Date 9/15/04 Property Address . . . . . . 78855 RIO SEGO APN: 646-330-037- - - Application .description POOL - RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL. Application.valuation . 17000 Owner Contractor M/M RICCI CALIFORNIA POOLS & SPAS 78-855 RIO SEGO P.O. BOX 1280 LA QUINTA CA 9.2253 COACHELLA CA 92236 (760) 398=922'2 WCC:. STATE FUND WC: 04600061168 0'1/01/05 CSLB: 65'6128 . 10/31/04 CCC: C8 -C27 -C29 -'C53 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 BLDG POOL PERMIT Additional desc Permit Fee 180.00 Plan Check Fee 117'.00. Issue Date Valuation _17000 Qty Unit 'Charge' Per Extension BASE FEE 45.00 15..00. 9.0000 THOU BLDG 2,001-25,000 135.00 ------------7--------------------------------------------------------------- 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 P.O. BOX 1504 a �ll�� 78-495 CALLE TAMPICO fIN VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 4 4 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: _ B �/3 Date: Applicant: Appllcanrs Mailing Address: Architect or Engineer: Architect or Engineer's Addres Lic. No., BUILDING PERMIT DECLARATIONS LIC NSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under pro i ' of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and ProfessionalsCode, and my Lice a is in II force and effect. S License Class Lice se o. (O 10 Date q ® Contractor WNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that am exempt fro�eontractors' 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 9 civil penalty of not more than five hundred dollars ($500).): C-) 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 orimproves 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 maintainork issd. ' ers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this. permit is orkersompensation insurance carrier a d licy number re: Cartier Policy Numbertl 61R, _ certify that, in the performance of the work for which thi CE is i ued,1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that�f I ould beta a subject to the workers'.compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those prg6jsions. Datey/ -7O Applicant WARNING: FAILURE TO SECURE WORkERS' COMPEN.SA1iON P60VE GEIS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($10(L,000)., ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS1EES. 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 ENT IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT and Safety for the 1. Each Y permit subject to the conditions and restrictions set forth on this application. person upon whose behalf this application is made, each person at whose request and for whose benefitwork 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, indemnity 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 wF*o enced within 180 daysfrom 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.ply with all city and county ordinances and state laws relating to building construction, a0d h� y authorize representatives of this county t nter upon the boproperty for inspection purposes. Date Signature (Applicant or Agent): r Page 2 Application Number' . . . . . 04-00006313 Date 9/15/04 Permit . . . PLUMBING' Additional desc Permit Fee 33.00 Plan Check Fee 8.25 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 240 Qty Unit Charge Per Extension BASE FEE 15.00 Special Notes and Comments POOL & SPA. 15 LF OF 41.BLOCK WALL CITY STND. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. Fee summary Charged Paid Credited Due Permit Fee Total 297.00 .00 .00 297.00 Plan Check Total 142.50 .00 .00 142.50 Grand Total 439.50 .00 .00 439.50 0