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04-4843 (RPL)Tihf 4 4 4" BUILDING & SAFETY DEPARTMENT P. BOX 1504 (760).777-7012 95 CALLE TAMPICO FAX (760) 777-7011 UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT ) t Application'Number . . . . . 04=00.00:4843 Date 6/09/04 Property Address . . . . . . 51300 AVENIDA JUAREZ APN:. .773-043-036-23 -000000- Application description . . . POOL - RESIDENTIAL Property Zoning . . . . .. COVE RESIDENTIAL Application valuation 15000 Owner Contractor ------------------------ ----=- ----------------- CLARKE WILLIAM H n',n FAMILY POOL CONSTRUCTION • ,�� :3� �s' 53300 •AVENIDA RAMIREZ bNffNe CA 9- LA QUINTA CA 92253 C -f �jlut�� 9Z2�J,� (760) 564-3655 WCC: STATE FUND WC: 1340322004 03/01/05 CSLB: 658996 11/30/04 CCC: C53-HIC -------------------------------------- Permit . . . . . . -------------------------------------- BLDG POOL PERMIT Additional desc . Permit Fee 162.00 Plan Check Fee 105.30 Issue Date Valuation 15000 Qty Unit Charge Per Extension BASE FEE '�� 45.00 13.00 9.0000�THOU BLDG -2,:'001-25,000 117.00 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 ---------------------------------------------------------------------------- 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 _ - P.O. BOX 1504 78-495 CALLE TAMPIt.D LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Dy — 4kzl %3 Applicant: I Architect or Engineer: Applicant's Mailing Address: VOICE (760) 777-701.- FAX 17-701;FAX (760) 777•'011 INSPECTIONS (760) 777-715; Date: mL;nneci or tnglneer's Address: Lic. No. BUILDING PERMIT DECLARATIONS I hereby affirm under penaltyof —LICENSED CONTRACTOR'S DECLARATION pequry that I am I ce under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License ' orce and effect. / License Class e No. /'Date _L Q� —MF I hereby affirm under penaltyof OWNER -BUILDER DECLARATION perjury that I am a empt 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, a ter, 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 rive hundred dollars (5500).): U 1, as owner of the property, or my employees with wages as their sole compensation. "if 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 „cork 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 1 am exempt under Sec. . BA P.C. for this reason Date - Owner - I hereby affirm under penalty of pe 'u s— WORKERS' COMPENSATION DECLARATION r) ry one o l e following declarations: KI 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 perforhance '/ of the work for which this permit is issued. Ihavisand willrr ntain work em compensation insurance as re uired b S Carrier 1 certify that, in the perfornance of the copensation laws of California. a IrFAIL hwith comply with those pro io Date plicant WARNING: RE TO SECURE WORKERS' CO CIVIL FINES UP TO. ONE HUNDRED THOUSAND C SECTION 3706 OF THE LABOR CODE, INTEREST, q y ection 3700 of Pri Labor Code, for the performance of the work for which this permit is • which thif; permit is issued. I shall not empl y any person in any manner so as to become subject that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor ode, I "it ISATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND AS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN ATTORNEY'S FEES. I hereby affirm under penalty of perjury that there is a construction lendinCONg LENDINGAGENCYoe �* for which this g agencypermit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address IMPORTANT y APPLICANT ACKNOWLEDGEMENT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on INS application. 1 Each person upon whose behalf this application is made, each person hose 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 ch agrees to, and shall, defend, indemnity and hold harmless the City of La Ouima, itta officers, agents and employees for any act or omission ictal o the work beim 2• Any permit issued as a result of this application become I and void if work is not rfcommenced ormed rwith wor ithin 180 dayttufrom datef issuance of this ance of such permit a cessation of work for 180 days will subject permit to ne Ilati n. I certify that Iavecad this application and state that thea fo n is correct. I agree to comply with all city and county ordinances and state laws relating to building constru n, nd re authorize representatives of this county t n the a / bove-mentioned property for inspection purposes. ate �rll Sig (Applicant or Agent): tr '. •.� SY�,I'I t,. 1. '� � i r. r f f Page 2 Application Number . . . . 04-00004843 Date 6/09/04 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 POOL.ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee summary Charged ------------------------------------- Paid' Credited ---------- Due --------- Permit Fee Total 240.00 .00 .00 240.00 Plan Check Total 124.80 .00 .00 124.80 , Grand Total 364.80 .00 .00 364.80 ` r f ti UQ DA