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04-3664 (RPL)cm s� BUILDING & SAFETY DEPARTMENT O, Box _504 (760) 777-7012 8-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA,CAiIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 104700003664 Date 4/23/04 Property Address . . . . . . ._.53780 DEL GATO DR APN: 770-370-010-109 -28867 - Appl,ication description . . . POOL - RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL .,Application valuation,: 30000 Owner Contractor CLEMENTS ROBERT E AINSWORTH POOL CONSTR, ROBERT PALM DESERT CA 9221.1 (760) 568-4993 WCC: AU INS SRVC WC: 00500018173 01/01/05 CSLB.: 59868.1. 07/31/04 CCC: C53 Permit . . . . BLDG POOL PERMIT Additional desc.'. Permit Fee . . . 284..50 Plan Check Fee 184.93 Issue Date Valuation 30000 Qty Unit Charge Per Extension BASE FEE 252.00. .5.00 6.5000 THOU BLDG 25,001-50,000 32.50 . 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 . . . . ... 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 • VOICE (760) 777-7012 79-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Architect or Engineer: Im Date: 6;,- aw' O or Engineer's Address: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty a perjury riot 1 am licensed under provisions a Chapter 9 (oamiencirp with Secbn 701)0) of Division 3 a to Business and Pmk"mionals Cleas /h �Code. and rrry �hr�l e.IeI foala • �l /' carter r cl� To ( otiP,JtC i A. OWNER43U4.DER DECLARATION 1 hereby affirm under penalty a perjuryfhst I am exempt from ger Contractors' Stab License Law for the fokw* ressan (Sec. 7031.5. Business and Pnolessions Code: Any city or county *;at M- Wres a per., to construct atter. improve. demoid or repair any structure. prior to Its issuance. also requires the appiant for fns permit to Be a sipred 'statement gnat he or she Is icansed pursuant to to provisions of to Contractors' StMe I kerhae low Poplar 9 (commencing with Section 7000) of Division 3 of ilia Business and Professions Code) or that he or she is exempt rierafrom and the basis for the alleged euemptim Any violation of Section 7031.5 by any appiant for a pamit subjects the applicant b a eivl penalty of not more than five hundred dolens OW).r U 1. as owner of the property. or my employees with wages as their sale commpe+setion, wo do to work. and the structure is not Intended or oflered for sale (Sec. 7044. Business and Pmaessioms Code: The Contractors' Stab license Law does not apply b an owner of property who builds or improves t1wear and who does the wait Nmsetf or herself or through his or her own employees, provided that the improvements are not inlenmded or offered for sale. K, however, the midi n or improvement is sold within one year a completion, the owner4jiider vA have the burden of proving fqt he or she did not build or improve ler 0% purpose of sale.}. U Las owner of the property. am exclusively contracting with iansed contractors to amshuct the project (Sec 7044. Business end Piaessbrn Code: The Contractors• Stale Lkmnse Law does not apply ban owner of property who bulls or improves rieieon, and who contracts for" projects with a contractors) icensed p mont b the Contractors' Stab License Law.). U I am exempt under Sea . B.6 P.C. for etre reason Date - Owner WORKERS• COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: _ 1 have and wit maintain a certificate of consent to self4rtsm ler wakes' conpensadon, as provided for by Section 3700 of the Labor Code. ler the performance of the work ler wtnich Itis Pamlt is issued. I have and wdl maintain workers' compensation insurance. as required by Semon 3700 of the Labor Code. for the performance a the work ler which On permit is Issued. My wonkes' eanpensatiar rce earlier and policy number are: Nmrnber _ 1 certify glial, M the penlomhance a the work ler whicln tis permit is towed, l chats rma ertpby any person to any roamer so as b becorme autmjed b the wakes' • compensation taws of and Mph i 1 sthould beconne subject b the vwrkas• oompahsatior provisars a section 3700 a the t.aba Code. l shat . fonehnlen oanrnply wlth chose / Cate "I L )4 104 WARNING: FAILURE TO SECURE WO CIVIL FINES UP TO ONE HUNDRED TF SECTION 3706 OF THE LABOR CODE. COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND q DOLLARS ($100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN ST. AND ATTORNEYS FEES. . CONSTRUCTION LENDING AGENCY 1 hereby sffum under penalty of perjury lot two is a construction lending agency for to performance of the work for which tis permit is issued (Sec. 3047. Civ. C.). Lender's Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application Is hereby made b the Daactor of Budding and Safety for a permit subject to the eondi6ons and restrictions set brth on this appiatiom i. Each person upon whose behalf this application is made, each person at wtcse request and for whose benefit work is performed under or pursuant to any permit issued as a result, of grit app60116 ►, the owner. and the applicant, each agrees b, and shat, defend. Ir derrtify and hold harmless the City of La Outnla, Its officers, agents and &TO"" for any act Of omission retated to the work being performed_ under or fodowiing issuance of Its permit 2. Any permit issued as a result of tis application becomes r*A and void N work is not cod within 180 days from date of Issuance of such permit or cessation of work ler 160 days wO subject permit b I certify that I have read this appiation and state that the ortm ia1 is con I to comply with ad city and county ordinances and state laws relating to building and hereby audarize representatives of this upon the above bored property ler inspection purposes. cons,truc"ig/a� lure (Applicant or Apert% Page 2 Application Number .04-00003664 Date ..4/23/04 ---------------------------------------------------------------------------- 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 ------------=---------------------------------------------------------------- Special Notes and Comments POOL/SPA. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. .EQUIPMENT ENCLOSURE NOT INCLUDED Fee summary . Charged ----------------- ---------- Permit Fee Total 386.50 Plan Check Total 210.43 Grand Total 596.93 Paid Credited .00 .00 .00 .00 .00 .00 Due 386.50. 210.43- 596.93 r