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05-0184 (RPL)oow °� BUILDING Sr, SAFETY'DEPARTMENT �P^O�`B03y�1504 1�►I' r (760),777-7012 OFT9 D 78�;�4:95�"�AMPICO CALL FAX (760) 777-7011 LA UINJA lliiR� Q CALIFO'NtA 92253 INSPECTION REQUESTS (760) 777-7153 �t BUILDING PERMIT ` Application Number', .,.05-00000184 Date 1/21/05 Property Address 80355 OLD RANCH TR•"S APN: 762-240-999-39 30834 - Application description POOL .= RESIDENTIAL Property Zoning . . LOW DENSITY RESIDENTIAL Application valuation. 31000, Owner Contractor SOUTH POINT CONSTRUCT. TOPMAN .80355 OLD RANCH TR SO. P.O. BOX -10202 LA QUINTA" CA 92253 PALM DESERT CA 92255 (760) . 772-7296 WCC: COMBINED.SPECLT WC: 005-J0025671 01/01/06 CSLB: 455121 .11/30/05 CCC: B -C29 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 <=10.0K' 9.00 ------------------_------------'_ -------------- ---------------------- -- -- ----------- -- Permit BLDG POOL PERMIT Additional desc Permit Fee . . . . 291.00 Plan Check =ee 189.15 Issue Date Valuation 31000' Qty. Unit 'Charge Per •Extension BASE FEE 252.00 6.00 6.5000 THOU BLDG 25,001--50,000 39.00 --------------------------=--------------------=----------;------------------ Permit ELEC POOL PERMIT -RES Additional desc Permit Fee . . . . 45.00 Plan Check 7ee 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 33.00 Plan Check Fee.. 8.25 P.O. BOX 1504 78-495 CALLE TAMPICD LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Architect or Engineer: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer's Address: Lic. No. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I h eby affirm under penalty of perjury that I am licensed and provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals de, and my License is in full force and effect. �1 ice se Class �-� cense No. Date -2-�k Cont or OWNER -BUILDER DECLARATION I hereby affirm under penalty of perju that I am ex mpt 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 c tract, alt , 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 pursua rovisions 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. , B.& 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 Kof 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 Cg v`P7:lk�j1=�'�C-%- olicy Number � .. C=>_=::>-2is to _ I certify that, inhe pe�ormance 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 of4OUSAND ee at, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall /Da/te forthwith comply with "Applica WARNING: FAILURE TO SECUREENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRELLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COND ATTORNEY'S FEES. \J CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address ` APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request.and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above inf a is ect. I agree to comply with all city and county ordinances and state laws relating to building cc ruction, and hereby aut�horizzee presentatives of this county t enter up th above-mentioned property for inspection purposes. Date ` Z��11 `$i n t g a ure (Applicant or I JI It I LAIC 1/8" 1 , _ O,PTr.00011))JIL of I f �l V I \ _.....__ SPECIFICATIONS I JI It I LAIC 1/8" 1 , _ O,PTr.00011))JIL of I f �l V I Page 2 Application Number 05-00.000184 Date 1/21/05 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 Special Notes and Comments POOL & SPA ONLY., ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged Paid Credite3 Due. Permit Fee Total 393.00 .00 .00 393.00 Plan Check Total 214.65 .00 .00 214.65 Grand Total 607.65 .00 .00 607.65