04-5272 (RPL)BUILDING & SAFEiTY,.DEPARTMENT
P.O. Box •1504
(760).777-7012
78-495 .CALLE TAMPICO FAX (760) 777-7011 ;
LA QUINTA, CALIFORN A."92253 INSPECTION REQUESTS (760) 777-71.53
BUILDING PERMIT
Application Number'
0� 4 0,00.052- 72 Date6/30'/04
• Property Address
5610 -8 -PALMS DR
APN:
764-030-003-23` -28983 -
Application description
POOL <'RES'IDENTIA'
Property Zoning..
LOW DENSITY RESIDENTIAL
Applica.tiori valuation :
;1800,0
Owner
contractor
BIRDIE HOMES LLC
CALIFORNIA POOLS.& SPAS
5 E CITRUS
REDLANDS SCA
P-. 0 BON 12 8 0 ,.,
COACHELLA CA -9 2 2'16
REDLAN S r -� ". CA.
923,74
('160) -.°398 .922,2: .
132 Za
WCC FUND
ISL.
STATE
WC 04600.061168
01/01/05
D
CSLB 656128
1Q/31/04
COQ -10E ,�
"
CCC. , , C8 -C27 -C2.-9 C53.
.
Permit BLDG
POOL PERMIT`
Additional desc..
Permit Fee 189.00:-.
:.Plan Check Fee
1122.85
Issue .Date
Valuation
18.000
Qty .. 'Unit Charg.e :.Per.
Extension
BASE -F•EE
45.0.0
_
16..00 9:.00.00 THOU :BLDG -2, 001'-.25, 000 9.
144:00
Permit MECH
POOL
. Additional desc .
Permit Fee "
2:4."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
P.O. BOX 1504 Taf
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0 Z- J:D 7a Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under p pigcion Chapter 9 (commencing with Section 7000) of Division 3 of Bre Business and, Professionals
Qpde,
and my Lfoenisinrce and elf C
se CIasL S
/ O ER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt fro a Co 'State License Law for the fop
city or county that requires a permit to construct, alter, I following ( 7031.5, Business and Professions Code: Any
Improve. li or repair, any stricture. 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 exeript therefrom and the basis for the alleged exemption. Any violation of Seddon 7031.5 by any applicant fore 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 time 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 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 oontrador(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. B.3 P.C. for this reason
Date Owner.
WORKERS' COMPENSATION DECLARATION
1 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
9of the work for which this permit is issued,
-1 have and will. maintainw ars' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which Amis permit is
iss d: M criers' pensationk�rarwe carrier an nu r a
I<rtier o'� licy NumberrcertiO j.
fy that In the performance of the work for whichthis "t is , I shall not employ any person In any.manner so as to become subject to the workers
compensation laws of California, and agree that, f(1 s ld me ubject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provj*ns: A
1/0
WARNING: FAILURE TO SECURE WOF*tRS' COM*SATIoNRA E IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DO 1. 000), IN ORION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN.
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTO EY'S FEES.
CONSMUCTION 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
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 agrees to, and shall, defend, indemnity and hold harmless the City of La Quanta, its
officers, agents and employees for any act or omission related to tt)e work bei performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work pnom oed within 180 days from date of issuance of such permit or
cessation of work for 180 days will subject permit to cancellation.
1 certify that I have read this application and state that the above inf mmation is co awith all city and county ordinances and state laws relating to building
construction, aand hereby authorize. representatives of this county rater upon th a party for inspection purposes.
mgnature (Applicant or Agent):
t
Page 2
Application Number . . .04-00005272
Date 6/30/04
Qty Unit Charge Per
Extension
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
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 PLR WATER'I-NST-/ALT/REP,
3.00
1.00. 3.'0000 EA PLB GAS PIPE 1'4 OUTLETS
3.00
Special Notes and Comments.
POOL/SPA, WATER .FEATURE, BBQ .(ANSI
Z21-58-1995) ALARMS/BARRIERS SHALL. BE
IN PLACE AT PRE 'PLASTER INSPECT' ION.
EQUIPMENT ENCLOSURE NOT INCLUDED-'
Fee summary Charged Paid Credited
Due..
Permit Fee Total 291.00 ^:00 .00
291.00
Plan Check Total 148.35' -,..0`0. .00'
148.35
Grand Total 439.35' .00.:.: 00
439.35
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