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04-6415 (RPL)°F �wQ�rw BUILDING & SAFETY DEPARTMENT P--.0:-Box._1504 _ (760).777-7012 78-495 CALLS TAMPICO FAX (760) 77717011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (766) 777-7153 BUILDING PERMIT Application Number . . . . ..fz-_-04=00006,4-1.5 Date 9/24/04 Property Address . . . . . . 52730 DEL GATO DR APN: 770-330-047- - - .Application description . . . POOL - RESIDENTIAL Property Zoning . . . . . : . LOW DENSITY RESIDENTIAL Application valuation . . . . 4800 Owner Contractor CASEY WESTERN POOLS 52730 DEL GATO DRIVE P.O. BOX 1047 LA QUINTA CA 922.53 INDIO CA 92201 (76.0) 200-1110 WCC: STATE FUND WC: 12709962004 02/01/05 CSLB: 348768 12/31/05 CCC: B-053 -------------------------------------------------- Permit . . . . . BLDG -------------------- POOL PERMIT Additional desc Permit Fee . . . 72.00 Plan Check. Fee 46.80 Issue Date Valuation . . . . 4800 Qty Unit Charge Per Extension BASE FEE 45.00 3.00 9.0000 THOU BLDG 2,001-25,000 27.00 -----------------------------7---------------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 ---------------------------------------------------------------------------- Permit PLUMBING Additional desc Permit Fee . . . . 27.00 Plan Check Fee 6.75 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 P.O. Box 1504 • VOICE (760) 77;-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: to Date: - Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS lA 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 bode, and my License is in full force and effect. cense Class C. !I it License No. �f Date -/ - Z -!J - Contractor LVPis�ell�t^ J�01 S OWNER43UILDER 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 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 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 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 ssyed. M workers' compensation ms ce caner 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. - zq -o 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 Ot Lehdees 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 Quints. 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 herebyauthorizerepresentatives of this countAR7ff,- n the above-mentioned property for inspection purposes. ate Z 7 'Signature re (Applicant or Agent): 9 Page 2 Application Number 04-000.06415 Date 9/24/04 Qty Unit Charge Per Extension 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 2 ENTRY WATER FEATURES 4' X 4' X 18" DEEP WITH 1 PUMP & 2 LIGHTS Fee summary Charged Paid Credited Due --------------------------- Permit Fee Total 144.00 -------------------- .00 .00 ---------- 144.00 Plan Check Total 64.80 .00 .00 64.80 Grand Total 208.80 .00 .00 208.80 9 lr..09/10/2004. 10:05 7603402852 JSLA IWTEM P00 78409 Darby Rd. Bermuda Dunes, CA. 92203 Ph. 760-200-1110 Fas 760-200-4777 Cell 760-275-2948 Building Pools and.5pas for over 25 yearf M�1 Ed'�7I� T1 00" 45; -{� F �•Ci -STV C Go 13. ENTRY WATERFEATURE 09/10/2004 10:05 7603402852 JSLA `� . SsTUGao -M�wD NG O . -Jot°"'F- M a hlplwe at SL -00. COO=. rte-. dEp�• P�►Rs a+ fie" o.c- . Tree , cox ro �►� X45' '56D O ►AGO la j a 144 CouNi��_ 1 U?L- gl.4T C* , I fwd R . o g 2 ENTRY WATERFEATURE s o� PAGE 03 • ''.'. _�s . w % . is �.:' - . } � , .' :e� oma;;.- `.i. .y� :.5'.•:f {:•:.. �Y.`. ��.'� .. g4 -�- .• '. .? <•, }'iY•• "i:r'�j'i _v'r '•i i'al .v- •••_ --gip. �' --F-..�� •,•.'y --:'�- ,�,e \ { i� ,�j� F ,�. �t: �r�• :a.:�►„•tq � • � - •: •'rte ' !i±-' �. _ ;i.� `�. • ' � e ir c��:`frs S�tA=,'- �� •• - ii+•^� "? 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