04-3553 (RPL)A _
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V ,l 4.A ^�APITA
'W BUILDING &. SAFETY DEPARTMENT
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P.O. BOX "1504 (7.60) 7774012
tOF•fti4.9 78-495 `CALLE TAMPICO FAX (760) 777-7011
LA .QMINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).777 -7153-
-BUILDING
BUILDING PERMIT
Application Number 04-00003553 Date 4/i6/04
Property Address . . 77255:CALLE NOGALES
APN: 773=311-00.1'26 =000000-
Application description POOL - RESIDENTIAL
Property Zoning COVE RESIDENTIAL.
Application valuation 12000
Owner Contractor,
ATWOOD LEON A OWNER
P 0 BOX 1167
LA. QUINTA CA .92.253
Permit MECH'POOL
Additional des.c.
Permit "Fee 24.0`0 ` Plan'' Check .Fere 6.00
Issue. Date Valuation 0.
Qty Unit -Charge Per Extension
BASE FEE 1.5.00
1.00 9.0000 EA MECH FURNANCE'<=100K 9.00
-------------------------------------------------------------
Permit . . .. . . BLDG POOL PERMIT
Additional desc
Permit Fee -135.00 Plan.Check Fee 87.7.5
Issue. Date - Valuation 12000
Qty. Unit Charge Per Extension
BASE FEE 45.00
10.00 9:00.00 THOU BLDG 2,00.1-25,000 90.00
Permit ELEC POOL PERMIT -RES.
Additional .desc
Permit Fee 45,:,0..0. 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 PLUM"BINE
Additional..desc
Permit Fee33.00 Plan Check Fee 8.25
Issue Date Valuation 0
P.O. BOX 1504
78-495 CALLE TAMPICO /:.
�I`/ VOICE (760) 777-7012
FAX (760) 777-7011
LA QUINT A. CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number.
Applicant:
�Appu�rt's Mailing Address:
BUI
Date: O 4- o?3-0
,Architect or Engineer.
or
lac. No. `�j_l I. I
NG PERMIT DECLARATIONS .
1 hereby affirm under LICENSED CONTRACTOR'S DECLARATION
PAY of perjury that I am licensed under provision; of Chapter 8 (commencing with Section 7000) of Division 3 of the Business and-Protessionals
Code. and my license is in full force and effect
License Class License No.
Dab - Contractor
1 hereby affimh under penalty of perjury that I am OWNER�BUUMER DECLARATION
exempt from the Contractors• State License Law for the following reason (Sec. 7031.5. Business and Professions Code: Any
city or county that a pemrii b crosbuct, after. improve. demrofish, or repair any structure. prior to its issuance. also requires the applicant for the permit to fie a signed
Statement that he or she is licensed pursuant to Iia provisions of tie Cw*actors' 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 pan* subjects
the applicant to a cavi penally of not more than five hundred dollars ($500).):
U 1. as owner. of the property. or my employees with wages as their sob compensation. will do the work, and the structure Is not Intended or offered for sale (Sea 7044•
Business and Professions Code: The Contractors' State License Law does not apply b an owner of property who builds or anproves 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. howeyer, the building or improvement is
sold within one year of completion, the owner -binder wig 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
State License Law does not apply to an owner of property who builds or' project (Sec. cts for
Business and with
Professions Cade: The Contractors'
the Contractors' State License law.). • and who contracts for the projects with a contractor(s) licensed pursuant b
U 1 am exempt under Sec. . B.& P.C. for this reason
WORKERS' COMPENSATION DECLARATION
1 thereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to setf4rhsure for workers' compensation, as provided for by Section 3700 of the Labor Code. ler the performance
of the work for which this permit Is issued.
_ 1 have and will maintain workers' compensation Insurance. as required by Section 3700 of the Labor Code. for the pertomnance of the work ler which this permit is
ler• My yrs' compensation Insurance carrier and policy number are:
carrier Polity Number
_ I certify that, to the performance of the work ler which this permit is issued. I shag not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that• if I should become subject b the workers' con
kfthw11h.OompIy with those pensation provisions of Section 3700 of the labor Code. I shag
tate J1 plicant C` �,
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 ATTORNEYS FEES. .
CONSTRUCTION LENDING AGENCY
hereby affirm under penalty of perjury that there is a construction lending agency for the perfomhance of the wok for which this permit is issued (Sec. 3097. Civ. C.).
Lender's Name
Lenders Address 1V 14
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.
I. Each person upon whose behalf this application is made, each person at whose request and for whose benefit wok Is performed under or pursuant to any permit
issued as a result of this application. the owner, and the applicant, each agrees to. and shag. defend. indemnify and hold harmless the City of Le Ouinta, its
Officers. agents and employees for any ad or omission related to the work being performed under or following issuance of this pemidL
2. Any permit Issued as a result of this application becomes null and void If wok is not commenced within 180 dalys from date of issuance of such pemdt, or
cessation of work for 180 days will subject permit to cancellation.
1 certify that I 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 to enter upon the above�rhenT�7= n purposes.
�BaCe �3'� signature (Appicant or Agent):
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A RE -INSPECTION FEE$30
0 F d
WILL BE CHARGED IF THE APPROVEDZ�l
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED f..
INSPECTION:
NO EXCEPTIONS!
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Page 2
Application Number . . . . 04-00003553
Date 4/16/04
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
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Special Notes and Comments
POOL & SPA ONLY. ALARMS BARRIERS SHALL B.
E IN PLACE PRIOR TO.PREPLASTER
.INSPECTION.
Fee summary Charged Paid Credited
Due
Permit Fee Total 237.00 .00 .00
237.00
Plan Check Total 113.25 .00 .00
113.25.
Grand Total 350.25 .00 .00
350.25