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05-0834 (RPL)% P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . 0=5='0.0.0-0=0.83_4, Date 3/14/05 Property Address . . . . ... 78765 NOLAN CIR APN: 604-233-022-19-1 -23268 - Application description. POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 17000 Owner Contractor ------------------------ HERTZBERG ------------------------ CALIFORNIA POOLS & SPAS 78-765 NOLAN CIRCLE P.O. BOX 1280 = COACHELLA CA 92236 LA QUINTA CA 92253 -(760) 398-9222 WCC: SEABRIGHT INS WC: BB1.050510 01/01/06 CSLB: 656128 10/31/06 CCC: C8 -C27 -C29-053 ---------------------------------------------------------------------------- Permit . . . .` . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 180.00 Plan Check Fee 117.00 Issue Date . . . . Valuation. . . . . 17000 F ' Qty Unit Charge Per Extension BASE FEE 45.00 15.00 9:0000 THOU BLDG 2,001-25,000 135.00 ----------------=-------------------------------------------- Permit ... . . --------------- MECH POOL Additional desc Permit Fee 24.00 Plan Check Fee 6.00 Issue Date Valuation.. . . . . 10 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 Pla ec oFee 11.25 Issue Date Val Oxtension 0 Qty Unit Charge Per MAR 2 12005 BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SW M (�pUUINTA 30.00 -----------------=--------------- ----jIAIAN DEPT Permit . . . . PLUMBING Additional desc P.O. BOX 1504 Twy,,f • w VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 41) 77 I Date: Applicant: Applicant's Mailing Address: (20.Wi Acro k) Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am license nder provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals de, and my License, is i�falpforce and effect. icense Class C— ✓J 15ate 137i1 )0 Contractor WN R -BUILDER 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 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 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 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 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. nd will ma}'�ain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is );hawve ¢y wcJfers' compensation insurance carriers icy�yfgbp�r :!amer I` Lt•L(.i Policy Num !� (• b5 & I certify that, in the performanceof the work fo hich this permit is issued, I shall not effiploy any person in any manner so as to become subject to the workers' compensation laws of California, and agre hat, i I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Dat 3 21 1 <.aplican WARNING: FAILURE TO SECURE WORKS S' COMPEN ON 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 Lenders Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Dire,ctor,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 oviner, 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 I have read this application and state that the above information i correct. I agree to comply with all city and county ordinances and state laws relating to building construction,, and h ereby authorise representatives of this county to ter u e above-mentioned property for inspection purposes. D /tezK l ��` Signature (Applicant or Agent): Page 2 Application Number . . . . . 05-00000834 Date 3/14/05 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 1.0.0, 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments POOL & SPA. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary ----------------- ChargedPaid Credited Due Permit Fee ------------------------------ Total 282.00 .00 .00 ---------- 282.00 Plan Check Total 142.50 .00 .00 142.50 Grand Total 424.50 .00 .00 424.50