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04-6544 (RPL)BUILDING & SAFETY DEPARTMENT P.O.. BOX 1504 (760)"777-70.12 78-495 CALLS TAMRICO FAX (760) 777=7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING. PERMIT Application Number 04-00006544 Date 9/30/04. Property.Address... 49335 AVENIDA FERNANDO .APN: 65.8-280-007-- Application.descrlption:. POOL --RESIDENTIAL �(,1 Property Zoning-. . . . LOW DENSITY RESIDENT Application valuation.. 16000 9�''',' Owner. Contractor -----------------Gwv<>%,fir_, 96:uZ� CLARK CONSTUTCTON CALIFORNIA PO S __PA_ 49335 AVE FERNANDO P.O. BOX'1280 LA QUINTA CA '92.253COACHELLA CA 92236. .. (.760) 39.8-92.22. NCC: STATE. FUND::' WC: .0'600061168 O1/0i/05 CSLB: 656128 1'0/31/04 CCC:.. C8. -C27 -C29-05,3 Permit MECH POOL Additional- desc Permit Fee . . . . 24.00 Plan Check Fee.. 6.00 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension: ,BASE PEE' -'15.00 '1.00 9.0.0.00 EA MECH.FURNACE <=1.00K 9.00 Permit.- BLDG POOL PERMIT .. , Additional'desc Permit Fee 171.00 Plan Check Fee 111.15 Issue Date Valuation 16000 .-Qty .Unit Charge Per Extension" BASE 'FEE .45.00 14.00 9.0000 THOU. BLDG 2,0.01-25,000 126.00 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 1W ' awP.6. Box 1504 / VOICE (760) 777-7012 79-495 CALLE TAMt1Co :... w FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS. (760) 777-7153 BUILDING & SAFETy DEPARTMENT Application Number. Date: Applicant: Architect or Engineer. Applicant's Mailing Address: Architect or Eno.dress: -14 Uc. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 heretit affirm under penalty of pw ny that 1 sm lioerised under provisions of Chapter 9 (oomn ndng wtth Section 7000) of DiNsion 3 of the'Bu*au and Prbtas Wws Code, and my Lloens&ls In full force and effect. /_ �!� �� g License Class [ -`. $ 3 License No, 6 Date r D ( coi►tractor CWNER43UILDER DECLARATION I hereby afrum under penalty of perjury that I am exempt from the Contractors' State License law for the toaowkng reason (Sec. 7031.6. Business and Professloru Code: Any city or county that requires a.pemdt to oanbvct, alter. improve. demolish, or repair any struckm pdW to Its Issuance, also regrrkes the applicant for the. pemmlt b file a sipnad statement that to or she is licensed pursuant to the provWms of the Contraclors' State Lkxrue Law (Chapter 9 (commencing with Section TM) of Division 3 of the Business and Professions Cole) or fiat 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 b a dvilpenally of not more than rnro hundred dollars ($SW).r U I, as owner of the property. or my employees with wages as their sole commper►tation, will do the work, and tie structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractors' State License Law does not appy ban owner of property who builds or Improves thereon, and who does the work himsed a herseff or through his or her own employees. provided that the improvements ars not Inlerded or offered for ago. K, however. the building or krprovement ds sold within one year of completion, the owner-buUder will havethe burden of p oving that he or" did not bufid or kTVmve for the purpose of sale.). (� I. as owner of the property. am wchatvely contracting with Iloensed contractors to conshvcd the project (Sea 7044, Business and Professions Code: The Contractors' State License Law does not appy to an owner of property who builds or improves thereon, and who contracts for the projects with a Cmtador(s) licensed pursuant to the Contractors' State License Law.). U 1 am exempt under Sea . B.3 PA. for this reason Vats Ovmer_ '. WORKERS' COMPENSATION DECLARATION hereby affirm under penalty of pe4ury one of the following declarations:. I have and will maintain a certificate of consent to selunsure for workers' conpensallM as provided for by Section 3700of the Labor Code, for performance of the work for which this permit is Issued.. I have and will maintain workers' compensation insurance, as required by'secliorn 3700 of the Labor Code, for the performance of the work for which this permit is My woeprs *Wgensation.lrisurance carrier and poricy�ytuber aro: Carder, -<�P .4-tl_&� & . Policy Number 0%=* l //le I.certify that; in the performance of the work for which this permmitis issued. I shad not employ any person in any manner so as to become subject b the workers' Compensation laws of California, and agree that if I should become subject b the workers' compensation prvAsions of Section 3700 of the Labor Code, I shad liorthhwltn comply with those 401 Date �PAppflcant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES bW TO ONE HUNDRED THOUSAND DOLLARS ($100.000).;N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR 114 SECTION 3708 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 (Sea 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 b the conditions. and restrictions set forth on this application. 1. Each person upon whose behalf this application Is made, each person at whose request end for whose benefit woeK is performed under or pursuant to any permit Issued as a result of this appl'icafion, the owner, and the applicant, each agrees b, and anal, defend, indemnify and hold harmless the Clty of Le Quints, Its officers, agents and employees for any actor omission related b the. ' wned-under or•foaowtng issuance of this pemNL 7- Any permit issued as a �resuft of this application becomes null and d wtxk fs commenced wlthin.180 days from data of issuance of such pertmmit, or cessation of work for 180 days will subjectPermit b pncellation 1 certify that 1 have read this application and state that the above Infommaton i b comply with an city and county ordinances and state taws relating to building IL construction, and hereby suft"te representatives of this countv& enter upon a toned property for inspection purposes. pate ` 0_ Signature (Applicant or Agent): i Page 2 Application Number . . . . . 04-00006544 Date 9/30/04 -----------------------------------=---------------------------------------- Permit PLUMBING Additional desc . Permit Fee 33.00 Plan Check Pee 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 ONLY. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged. ----------------- Paid Credited Due -------------------- Permit Fee Total 273.00 ---------- .00 .00 ---------- 273.00 Plan Check Total 136.65 .00 .00 136.65 Grand Total 409.65 .00 .00 409.65