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04-3931 (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) 777-71.53 BUILDING PERMIT Application Number Property Address . . . . APN: Application description,;. Property Zoning . . . . Application valuation Owner CERVELLO CHARLES ` 79806 SHADWELL CIRCLE LA QUINTA CA LA QUINTA CA 92253 C0_4=0-0-0_0_3_9_1_1___Date 5/ 0 6/ 04' 79806 SHADWELL CIR 604-483-011-21 -24197 - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 21500 Contractor -------=---------------- MC CALLUM POOLS 82762 CHARLSTOWN.AVENUE INDIO CA '92201 (760) 275-6403 • ERMIT-RES Additional desc Permit Fee 45.00 Plan.•Check Issue Date . . . . Valuation Expiration Date 11/06/04 CITU WCC: EXEMPT WC: EXEMPT 05/13/04 CSLB: 818838 04/30/05 ----------------------------------- CCC: C53 BLDG-POOL PERMIT Additional desc Permit Fee 225.00 Plan Check Fee 146.25 Issue Date Valuation., 21500 Expiration Date .11/06/04 Qty Unit Charge Per Extension BASE FEE ,45.00 20.00 ------------------------------------=------7--------------=------------------ 9.0000 THOU BLDG 2,001-25,000 180.00 Permit . . . . MECH POOL Additional desc ' Permit Fee' 24.00 Plan.•Check Fee 6.00 Issue Date Valuation . . . . 0 Expiration Date 11/06/04. Qty Unit Charge Per Extension BASE FEE 15.00 1.00 ---------------------------------------------------------------------------- 9.0000 EA MECH FURNACE <=100K 9.00 Permit ELEC POOL P • ERMIT-RES Additional desc Permit Fee 45.00 Plan.•Check Issue Date . . . . Valuation Expiration Date 11/06/04 CITU P.O. BOX 1504• ��r��j rV VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: comet'' -513 1 1 Date: Applicant: Applicant's Mailing Address: ky� 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 licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and ss License} i� I� force and effect. —s �) License Class 11,, � License No. � —0-0 P,::, Q lr ��c L v 1 q p._� OWNER -BUILDER DECLA ON 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 fora 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 1 am exempt under Sec. , BA P.C. for this reason Date Owner. WORKERS' COMPENSATION DECLARATION 1 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. 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 insurance carrier and policy number are: Carrier Policy Number I certify that, in the performance of the work for which this permit is issued, I sh II 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 subje to Fye workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with SboS�provision _ I 5-) 7<_,,�( ooli� 1\ L V" i WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVEitkM-IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED T 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 pernit is issued (Sec. 3097, Civ. C.). Lender's Name - Lenders Address 1 — 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 Ouinta, 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 be 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. 1 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 hereby authorize repr�ntativesty to ent"pon the above-mentioned propertyfq inspection purposes. ' Signature (Applicant or Agent): / v Page 2 Application Number 04-00003931 Date. 5/06/04 Qty Unit Charge Perf, Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 Permit . . . . PLUMBING Additional desc Permit Fee 187.,00 Plan Check Fee 21.75 Issue Date Valuation . . 0 .Expiration Date 11/06/04 Qty -Unit. Charge Per. Extension BASE FEE: 15.00 2.00 6.0000 EA. PLB .FIXTURE 12".00 10:00 3.0000 EA PLB WATER INST/ALT/REP' 30.00 10.00 3.0000 EA PLB GAS PIPE 1 -4 -OUTLETS 30.00 Special Notes and Comments POOL/SPA. ALARMS/BARRIERS SHALL BE IN_. PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee summary Charged Paid Credited Due Permit Fee Total 381.00 .00 ,0.0 381.00 -Plan Check Total 185.25 .00 00 185.25 Grand Total 566.25 .00 .00 566.25 a O � r J � F W J oy moo a�ul W6 LU 0 g c) < Lu Yom_ Him 9� X85 co d a w 0 f te 4 w.n - � Z • z b 91. . b. A RE-INSPE.CTIO.N FEE OF $. 0 WILL BE CHARGED IF THE APPROVED c . PLANS AND JOB CARD ARE NOT ON THR SITE; FOR A SCHEDUUED INS ECTION. -� NO EXCEPTIONS! j 1 CITU OF L QUANTA BUILDING &SAFETY DEPT. APPROVED. FO C NSTRUCii N DATE a . BY Z'd S89SSLL09L wnjjebow ydosor d62?60 b0 SO ReW. CITY OF LA QUANTA SUB:COI TRACTOR LIST JOB ADDRESS PERMIT NUMBER OWNER BUILDER This form shall be posted on thewith the Building Inspection Card at all times -in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this Job Any changes to this list must be approved by the Building Division prior to commencement of work: Failure to comply will result in a stoppage of work and/or the voidance. of building. permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. 9 ........ ....... :. ... x .....:::::................................. . ::.:.. ::.;:.. 'C. .::::.......................................�......�t........ .................................................................. c� 8a or.:;.;:.;:.:;.;:.;:;.:;:.;:.;:.;:.;;:.; . ...... .:... :taf:+v�nt�ractor x........ ....:::::.....:::::.:::::.:::::.�::::.................................. .:................................................................. ......................................................::. ... fret .mom tsati............................................ .....ens............ n Name Companya Classification e. 9 .ABC - 8 1 nse Number er l'ce ( zxx xx X 1 Ex . Date xx xx xx ( 1 r Name Carrier e Fund CaICo m . e. State 1 ( P 9 Policy. Number Varies) var Format 1 Exp.. Date xx xx - 1 xx/ 1 License nse N um ber xxx x 1 Exp.. Date xx xx xx/ 1 1 %AL a - av LOS 2S -7 �a2 s S��+e rtiN� ayy��-�c�v� �°s �- i �� , � l ,� .,` �a �I C 5 1 �3 � -O s M t� rF .. - �P 7 w �.� e� 1. 4 _ r ....... VVIc P � C 3 cg ' 1 c �,.