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04-4385 (RPL)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT' , Application Number . . . . 04-00004385 Date 5/18/04 Property Address . . . . . . 45130 COLDBROOK LN APN: 604-412-022-4 -23995 - Application description . . . POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 21500 Owner Contractor -------- ---------- �:� - - -------=-=-------------- MULV ST2`RH_,AN M MC CALLUM POOLS 30 GO'LDBROOK 46576 VIA CELESTE ' tilt INTA U CA 92253 INDIO CA 92201 1001, ) 775 0 0, P WCC: EXEMPT WC: EXEMPT 05/31/05 CSLB: 818835 04/30/05 CCC: C53 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 . . . . . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 225.00 Plan Check Fee 146.25 Issue Date . . . . Valuation . . . . 21500 Qty Unit Charge Per Extension BASE FEE 45.00 20.00 9.0000 THOU BLDG 2,001-25,000 180.00 ---------------------------------------------------------------------------- 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 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: L — Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's r 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 my License is in full force and effect. g 1 g Q S License Class C 5 License No. Date 'r- Z '�' Contractor � ` Vh c 1 OWNER -BUILDER DEC N I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law or the following reaso ec. 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 stile 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.). (--) I, 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 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ 1 have and will maintain a certificafe 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 issued. My workers' compensation ingjurancearrier a d policy number a ry61i'�y 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 C lifomia, and agree that, if I should become su ed o workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply w' those p isions. Date Z o Applica V u WARNING: FAILURE TO SECUR WORKERS' CO PENSATION CO GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED OUSAND OLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, T. 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.). Lender's Name Lenders 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 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this co nter upon the above -mention rt for inspection purposes. VDate 2 Signature (Applicant or Agent): v - :: , Page 2 Application Number . . . . . 04=00004385 Date 5/18/04 -------------------------- ------------------------------------------------- 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 ONLY. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. Fee summary Charged ----------------- Paid Credited Due -------------------- Permit Fee Total 327.00 ---------- .00 .00 ---------- 327.00 Plan Check Total 171.75 :00 .00 171.75 Grand Total 498.75 .00 .00 498.75 May 18 04 09:17a Joseph mccallum 7607755685 p.2 A RE-111SPECTION v FEE OF $30 WILL BE HARGED I PROVED PLANS ND JOB CARD ARE N THE SITE FOR _. CHEDULED INSPEC ION. - ® NS! O N n V a e •, s ' o oNo� ~m� o �� ppm�I� PH yzro Z O = fox 0 D D0z ag, OF� W rc— � m0 0 O f C i N W C7 01 a2 g CITY BUILD A� f jU( DATE Ld )F LA QUINTA G & SAFETY DEPT. PROVED BY. Q ca I.VVvei'lI CS FUMM'"Allis"MMM; . . . . . . . . . . . . . . . . . . . . . . . . . . ........... . . . . . . ..... 993-5 11-1