05-1315 (RPL)�x 1504
CALLE TAMPICO
NTA, CALIFORNIA 92253
BUILDING PERMIT
tir.N
Application description .
Property Zoning . . . . .
Application valuation . .
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
05-00001315
53640 AVENIDA CORTEZ
774-102-007- ' -
POOL - RESIDENTIAL
COVE RESIDENTIAL
15000
Date 4/07%05
Owner Contractor
PACIFIC HOMES PACIFIC HOMES
P.O. BOX 102:3 P.O. BOX•1023
LA QUINTA CA 922.5.3 LA QUINTA CA 9224.7
(760) 408-349.5
WCC: STATE FUND
WC: 1576557 08/01/05
CSLB: 782324 08./31/06
CCC: B
Permit . . . . . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 162.00 Plan Check Fee 105.3.0
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 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 . . . . 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 30.000,0 EA, ELEC PRIVATE SWMMING POOL 30.00
Permit . . PLUMBING
Additional desc . .
Permit Fee 33.00 Plan Check Fee 8.25
' C �
P.O. BOX 1504•� VOICE (760) 777-7012
78.-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT f' .
r
Application Number: Jr- / 3 / S r'Date:�� OS
Applicant:
Applicant's Mailing Address:
CyoHrCA 7V It'
Architect or Engineer:
Architect or Engineer's Address-.
AIA.
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury. that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of:the Business and; Professionals
Code, and my,Lie a is in full'force and effect. ✓ r7 9Z 2-4 4
License Class License No. l
1 Contractor
OWNER -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 Coder 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 orsheas licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing -,with Section 7000) of Division,3 o1 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 byanyappficant for a permit subjects
the applicant to a°civil penalty of not moreahan 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 thwwork
himself or'herself'or through his or her own employees, provided that the improvements are not intended or offered for sale: lf, 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;theproperty, am exclusively contracting with licensed contractorsito 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 conhactbr(s) licensed pursuant to
the Contractors' State License Law.).
U I am exernptunder Sec. , B4 PZ.. for.this reason
Date Owner.
WORKERS' COMPENSATION DECLARATION
hereby affirm under penalty of perjury oneof the following declarations:
_ I have and will maintain a certificate of,cwnsenttoself-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 pennitis
,.,-r sue . workers' compensation, insurance carder
.—I certify that, in the performance of the work for which this permit is,issued, f shall,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 to the workers' compensation' provisions of Section 3700 of the Labor Code, I shall
fo with complywith those provisions. �1.
,/late Applicanf (.i�`'�>'rt�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), INADDITION 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 thatthere is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name 41
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application isihereby madedo 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, andshall, defend,, indemnity 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 resulbof 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 160 days will subject permit to cancellation.
I certify that I have read this'application and'state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and jhereby authorize• representatives of this county to—anter upon the above-menfi erty for inspection purposes.
✓ j( �
Date (� Signature (Applicant or Agent):
.Page 2
Application Number . . . . . 05-00001315 Date 4/07/05
Issue Date . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE .1.5.00
2.00 6.0000 EA PLB FIXTURE 12.00
1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00
1.00 3.0.000 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
Permit Fee Total
Plan Check Total
Grand Total
Charged
2.64.00
130.80
394.80
Paid Credited Due
.00 .00 2.64.00
.00 .00 130.80
.00 .00 39.4.80
.`�M gAloeb +ISa
TILE SPILZ%S W
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DAT
53640 AVENIDA
774-102-007-
Maxie-
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