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04-7466 (RPL)Q• • opo. .B.UILDING-& SAFETY DEPARTMENT CA \, —P-07B-@xj­1-504.,­ (760),777-7012 CALLE TAMPIcO FAX (760) 777-7011 LA.QUIiNTiA, CALIFORNIA 92253 INSPECTION."REQUESTS (760) 777-7153 NOV 2 12004, BUILDING PERMIT CITY Ole Lh 1,4WV ITA FINANCE DEPT. � Application Number 0477_0.0=0-074.6.6 Date 11/24/04 Property Address :51..44.4 CALLE PALOMA_ APN: 770717;370067183-000,000- Application description: .. kP00L' Y .RESIDENTIAL Property-Zoning LQW:4DENSI7Y RESIDENTIAL Application valuation 27000 Owner Contractor --- -------------------- - t--------- - -.- -- =- ANNA NILSSENSUNAIR POOLS: 51444 CALLE PALOMA 72794 RANCHO GRANDE LA QUINTA . CA 92253 PALM°r"DESERT CA 92260 (760) "568-4Q.;14 . , WCC: STATE "FUND_ WC 05173.1'6 01/11/05. CSLB: 397;252 12/31/04 . CCC :, , C53' , Permit.. . . . . . MECH POOL- Additional desc Permit Fee'.. 24.0.0 Plan Check Fee 6.00 Issue Date Valuation . . . . 0 Qty. , Unit Charge•..:,•Per --I Extension BASE FEE 15.00 1 :°00 9.'0000' EA MECH; FURNACE <=100:K t .. 9. 0.0 ---------------------- --•.------------- -----------=--------- Permit BLDG POOL PERMIT:.'` -- Additional desc . Permit -Fee 265.00 Plan,CheckFee .172.25 Issue Date valuatioft"'. . . 27000 Qty Unit Charge Per Extension BASE FEE 252.00 2.00 6.5000 THOU BLDG,_25,001-50,-000 ..13.00 Permit . . . ELEC POOL PERMIT-RES Additional desc . Permit Fee ...45.00 Plan Check Fee 3.75 Issue Date Valuation 0 Qty Unit'.Charge Per.` Extension BA8E:-FEE 15.00 1.00 30y.0000 EA :ELEC_;'PR.IVATE SWIMMING POOL. 30.00 ----- --------- ----- -- ,�------ ---- PermitPLUMBING - --------------------- Additional desc Permit Fee _ 27.00" Plan Check Fee*. 6.75 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: U7 _ Applicant: ^� ' Applicant's Mailing Address: Date: //— c— Y r _?9 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 License i T1 f and effect. /+Z2-- License Class ss License No. �G Date 24-0 ContractoryN� �e— 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 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 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 maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is s ed. workels' comp ation insurance carrier and pgjjGygy�ber :� Carrier w PolicyNumber � / L —rcettify 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 a ree that, if I should become subject to the workers' compensation provisions of Sectiori 3700 of the Labor Code, I shall forthwith comply with those provisi s. Date `/ Z�� Applicant a WARNING: FAILURE TO SECURE W KERS' COMPENSATION COVERAGE UNLA F , AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION T HE 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 performanceof 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 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 canc on. I certify that I have read this application and state that the above i rm io is cwr . I agpo to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this cou to e e po t above- ntioned property for inspection purposes. Date ` Signature (Applicant or Ag t _ .. T. - ' Page 2 Application. Number 04 '0.00074'.66•' Date 11/24/04 i Issue Date val%iation 0 Qty' Unit Charge ' Per Extension, . BASE FEE 15.00 1.00- 6 .• 0 0 0 0: EA PLB: FIXTURE ;_ 6.00 1.00 3 .;0000 .EA PLB` WATER .I' ALT/REP 3.00 1._00 3.;0.000 EA PLB GAS :PIPE, 1 4;:.. OUTLETS'., 3.00 _ _ _ _ _ _ _ _. _ ------ _ _ _ _ _ _ _ _ _ _ __ _ _3, --------------------- . Special.;Notes and Comments POOL/SPA ONLY. PERMIT b.OES NOT." .INCLUDE,-,:;, BLOCK WALLS .OR EQUIPMENT. ENCLOSURE. ALL, . ALARMS:/BARRI'ERS. MUST ,.BE; 'IN PLACE'':PRIOR -. TO PREPLASTER INSPECTION. Fee summary Charged.`` ":Paid Credited. Due Permit .Fee .Total 3,61:00 :. .0.0 .00 361.00 Plane. Check Total 188;:75 '. . 00 00 188.75 Grand Total r. 549.7"5.: .00 :00 549.75 t P.O. BOX 1504 - 78-495 CALLE TAMPICO LA QUINTA; CALIFORNIA 92253 Application Number 0'47 Property Address: X00 51444 CALliEPALOMA APN: 770-173-006-183 -000000- Application description: POOL - RESIDENTIAL Property Zoning:.. LOW-DENSITY RESIDENTIAL Application valuation: i 27 Applicant: MAY13.2005., rchitect or Engineer: 01sk 4 :i VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 5/13/05 Owner: ANNA NILSSEN 51444 CALLE PALOMA LA QUINTA, CA 92253 --------------------------------- Contractor: Owner ------=---���---------- ------ LICENSED CONTRACTOR'S DECLARATION WORKERS COMPENSATION DECLARATION - I hereby affirm underApenalty, of perjury tK t I. amilicensed undeu provisions of Chapter 9 (commencing with (hereby affirm under. penalty of perjury one ofathe following declarations: . Section 7000) of Division 3W the -Business and Professionals Code, and.my License is in%full force and effect. _'I have and.will maintain`acernhcate'of consent. to self -insure for workers' compensation, as provided License•Class: : - LicenseNo.: - foi-by will 3700 of the'La' bor"Code, for.the performance of the work for which this -permit -is issued:.. Date: Contractor... _ - _ I have and.will maintain worker's' compensation insurance; as required by Section( 3700 of the Labor Code;:forthe performance of.the`work'for which this permit'.is issued. Nly workers' compensation - OWNER -BUILDER DECLARATION insurance'carrier and policy number are: - -1 hereby affirm under. penalty of perjury that I aexempt from -the Contractor's State License Law for ihe Carrier - ` Policy Number following reason (Sec _7031':5, Business and Prm afessions'Code: Any city or county that requires apermit to 6 certify that, in the performance of the work for which this permit is issued, I. shall not employ any construct; alter improyeydemolish, or repairany`structure, prior to its issuance, also requires the applicanrome subject for the person in any -manner so as beciothe workers' compensatioriaawsof California, permit to file a signed'statementthat he or sheds licen'sed,pursuantto the'provisions:of:.the:Contractor's State � � and agree that, if I should become subjectto the`�workers'compensation provisions of Section License.Law (Chapter.9`tcommencing w,ifh-.Secnon'7000) of. Division 3.of the Busmessrand Professions Codel or }370 f..the_ Labor Code,.) shall•forthwith comply'with those provisions. that he or;she is bkempiiher6irom and the basis for the a)leged_ezemption.:'Any violation of Section.7031:5 by- --� any applicant for a permgsubjects the applicant to a civilpenalty of not more than five hundred.dollars (5500).: I, as.owner 'of.the property;. or my employees with wag'e'sth will do.the work;and Date: ,ppbcant -r ,as.evscle.compensation, the structure',is,not intended-oroffered for. sale.(Sec. 7044, Business and Professions Code: The -.' WARNING.' FAILURE.TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL, AND:SHALL Contractors', State. License Law does not apply to an ownerof-property who builds'or improves thereon, `SUBJECT AN EIM.PLOYER TO CRIMINAL PENALTIESrANDr .iViCFINES uP TO ONLHUNDRED'THOUSAND - IS100000). and, who'does:the work himself or herself through his or her own employees, provided that the DOLLARS IN ADDITION TO THEA"CO ST;OFICOMPENSATION, DAMAGESAS'PROVIDED FOR IN .improvements are not intended'or offered for sale. If, however, fhe'building or, improvement is'sold-within -SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. one year, of completion, the owner -builder will have the burden of piovindthat he or she did not build or improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT ,..AI,,as;owner.of the property, am exclusively,contracting.with licensed contractors to:construcrthe project (Sec. IMPORTANT Application is hereby made fo:1heDirector. of'Building.and Safety for apermit subject to the-s'r- . - 7044, Business and Professions Code: The Contractors' StatelLicense Law does not.apply'to an owner of conditions and restrictions set forth onthis application. property who builds or improves thereon, and who contracts for the projects with acontractor(s) licensed t. Each person upon whose'oehalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). - whose benefit work is performed _under or pursuantto anypermit issued as a result.of-this application, I—) 1 am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agentsand employees for any act or omission related to the work being wA 21A2. performed under or following issuance of this permit. �te: Ws caner: 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 CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. Iagree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances andstate laws relating to building construction, and hereby authorize representatives of this county to ent on the above-mentioned property for inspection purposesr Lender's Name: -A/�/�'�'- PAW ate- 13,V ignature (Applicant or Agent): Lender's Address: LQPERMIT y o� LQPERAIIT Application Number . . . . . 04-00007466 Permit . . . BLDG POOL PERMIT Additional desc . Permit Fee . . . . 265.00 Plan Check Fee 172.25 Issue Date . . . 11/24,/04 Valuation . . . . 27000 Expiration Date 5/24/05 Qty Unit Charge Per Extension BASE. FEE 252.00 2.00 6.5000 THOU BLDG.25,001-50,000 .. 13.00 Permit MECH POOL Additional desc . Permit., Fee 24:00 -.-Plan Check. Fee .. 6.0`0 Issue Date, ..: .l1/24/04 Valuation 0 Expiration Date °5%24/05 Qty Unit Charge- Per Extension BASE FEE. 15:00. 1.00. 9.000.0 EA MECH FURNACE <=100K 9.00 Permit ELEC POOL,PERMIT RES Additonal','desc Permit Fee . 4'5.00 Plan Check Fee'. 3.75 ?1ssueDate ._ 11/2,4/04Valuation. 0 Expiratioft Date. 5%24/.05 Qty Unit Charge-. Per Extension BASE..FEE 15`. 00 1.00 30.0000 EA ELEC PRIVATE- SWIMMING POOL'.30:00 Permit PLUMBING Add'i'ti' rial,'desc • .:-. ..Permit Fee'. -.2.7.00. Check. Fee 6::75; . Issue Date' .. ..P1ari 11%24/,.04 Valuation' 0. Expiration Date, 5/,24/.05 Qty unit Charge Per Extension ,.. BASE `°'FEE 15""09 . 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 ---------------------------------------------------------------------------- Special Notes and Comments POOL/SPA ONLY'. PERMIT DOES NOT INCLUDE BLOCK .WALLS OR EQUIPMENT ENCLOSURE. ALL ALARMS/BARRIERS MUST -BE IN PLACE PRIOR , J LQPERMIT t Application Number . . . . . 04-00007466 ---------------------------------------------------------------------------- Special Notes and Comments TO PREPLASTER INSPECTION. SUPPLEMENTAL,TOORIGINALPERMIT_f� REFLECTING CHANGEi.,MF CONTRACTOR ASx 5 y, _ r .OF -------------------------------.--------- Other'Fees CHANGE OF CONTRACTOR 4.50 Fee summary Charged Paid Credited Due .••Permit Fee Total 36.1.00 3.61.0.0 .00 .00 Plan Check Total 188.75 188.75. .00 .00 Other`: Fee Total 4.5.0 00 00". 4.50 Grand Total 554.25 549.75 .00 4.50 J LQPERMIT CITY OF LA QUINTA SUB-CONTRA TOR LIST. JOB AD R E S S S/yyy &-,Ile- A/014el, • PERMIT NUMBER _ OWNER f91Vn/d W'15Sc� BUILDER This form shall form shall beposted on the job with the Building Inspection Card at all times in a conson the job with the Building Inspection Card at all times in a consQicuous 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. Trade /Classification Contractor State. Contractor's License,' Workers Com ensation In City Business License. Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C=12) , CONCRETE' FRAMING. (C-5) STRUCT.. STEEL (C=51). MASONRY (C-29) PLUMBING (C-36) tf! PLASTER (C=35).6 -3 a oos' .S� �` oro .[ivS ✓.� ��f0� b - - D� -3/ 3 Wo- DRYWALL (C-9) HVAC (C-20) �- ELECTRICAL (C-10) ROOFING (C-39); ^ ; SHEET METAL (C-43) FLOORING (C-15):: GLAZING (CA7) INSULATION;(C 21: SEWAGE D)SP (C.42) PAINTING (C:r33) CERAMIC TILE (C-541 ; CABINETS !C 6) FENCING (C ;13) LANDSCAPING IC 271 POOL (C 5% e n IS C-S-3 2 3 -Alo e—rm e?e