04-7020 (RPL)s BUILDING & SAFETY DEPARTMENT
O. _BG, x11504 (760).777-70:12 . .
bt,!p � 78-495 LLE TAMP.ICO FAX (760) 777=7011
U LA QUINIrA, CALtFORxIA.92253 INSPECTION, REQUESTS (760) 777-7153
NUV. 08 2004 .. BulLD
ING. PERMIT
CITV OF ( UINTA
13EPT.
er 04.-_Q0.0.07020 Date 11/05/x)4
Property .AddreS.s_ .. . . . 80365 TORREON WY
APN: 772-250-997-137 -31349 -
Application:descr.iption .:. POOL ._.. RESIDENTIAL
Property-,.'Zoning LOW DENSITY RESIDENTIAL
Appl,icat.ion valuation ..': 17000
Owner,, Contractor'
TOLL CA V OWNER
C/0 KEVIN.D DUERMIT
.89.01 E MOUNTAIN VIEW. 200.: ..
SCOTTS:DALE AZ 8 5.2 5 8 . .
Permit . MECH POOL
Additional.desc
Permit, Fee 24.00P1an Check .Fee 6.00
Issue Date Valuation 0
Qty Unit Charge PerExtensNon _
BASE 'FEE 15..00
1.00 9.0000 EA MECH FURNACE <=.100K 9.00..:.,.
Permit BLDG. POOL PERMIT
Additional' "desc ' .
Permit. Fee - 180.00 , Rlan. Check Fee : 117.00
Issue Date. Valuation.. 1.7000
Qty. Unit Charge Per Extension.
BASE FEE 45.00
15..00 9.0000 THOU..BLDG.2.,001-25,000 135.00
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
P.O. BOX 1504 A"
• ��r�7N�
79-495 CALLE TAMI'ICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number. 6• q—
Applicant:
Applicant's Mailing Address:
12r -
Architect or Engineer
Architect or
Lic. No.:
BUILDING PERMIT DECLARATIONS
VOICE (760) 7.77-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153-
Date:
77-7153
Date:
I hereby affirm under penally of LICENSED CONTRACTOR'S DECLARATION
gg perjury that 1 am licensed under provisions of Chapter 9 (Qoptrnenein0 with Section 7000) of Oivition 3 of the'Buskress and Professionals
LicensCodee ��L-- Is 53 force and effect Cpo 12 $
License No. c
Date d. Contractor
1 hereby affum under OWNER -BUILDER DECLARATION
Petty of perjury that I am exempt from fie Contractors' Stab "a
License Law for the wing reason (Sec. MIA. Business A
ass and Professions Cony
city or county that requires a Permit b , cw4b% 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 ffme Contractors' State License Law (Chapter 9 (commencing with Section TWO) of Division 3 of the Business
and Professions Co4e) or that he or she Is exempt therefrom and the basis for time stoped exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant b a C" penalty of not mora than five hundred dollars (t5W).r
(, I. as owner of the ptopaRy, or my employees with wages as their sole compensation, win do the wok, and the structure is not Intended or offered for sale -(Sec. 7044,
Business and Professions Code: The Contractors Stab License law does not appy b an owner of property who bu4ds or improves thereon, and who does the work
himself a herself or through his or her own employees. Provided that the improvements aro not Intended or offered for sale. If. however. be building or kmptoverrbnt is
sold within one year*( completion, the oww4jilder will have. the burden ofprovkp thtrtheorshodidnotbubdorin;x for the purpose of sale.�
() 1, as owner of the property. am errdusively contracting with licensed contractors b oonsbuct the Project (Sea 7044. Business and ProlaWona Code: The Contrectos'
State License law does not apply to an owner of Prop84 who bunds Or k VMM lhereM and who contracts for the projects with a oottrador(s) kensed pursuant to
be Contractors` State License Law.).
(, I am exempt under Seo. _ B.6 PIC. for this mason
o
Date
Owner_':._
1 hereby affirm under Penalty of perjury omit of lite tot WORKERS' COMPENSATION DECLARATION
_ t have and.wM maintain a certificate of consent to ss6lf4r" for workeM
of the work for which this permit is Issued.. cern as provided for by Section 3700 of thq Labor Code. for the performance
I-have
uua�and will wmoarirnrasinowoorr�keernmssacorpansatlon Insurance, as required by'Se tion 3700 of the Labor Code, ter be performance of to work br wtdch this permit is
Caroler <i -P .�[-r �,. , �1 tion f� nbe mer and po�y�ymber aro:
Policy Number
l.ce tify that in the performance of the work for which this' per itis issued. I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Caldomia, and agree that UJ should become subject Io the workers• com
bdhwhh comply with hose Pns peAsation provisions of Section 3700 of the Labor Cods,. I shad
WARNING: FAILURE TO SECURE WORKERS' C04PENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100, 000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR 4N
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
te affirm under CONSTRUCTION LENDING AGENCY
1 be
by Pett of perjury that here fs a oonstnrctlon larding agency for Cmc performance of be work for which this permit Is Issued (Sea 3097. Civ. C:).
Lenders Name:
Lenders Address
IMPORTANT Application is hereby made to the Director of Building and Safety ACKNOWLEDGEMENTtothe•
1. Each person upon whose behalf this a subject b � conditions and restriction' sat forth on this appdcatiori.
Pplicatiot 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 aPPlk;atlon, the owner, and time applicant each agrees b, and shad, defend. Indemnify and hold hamVess the City of La Oulnta, its
2
officers, agents and employees for any act or omission related to om
not
the wd-under W following Issuance of this pernd:
Any permit Issued as a resuft of this application becomes nun and void if lied within -1180 days from date of Issuance of such pwmk or
cessation of work for 180 days will subject permit to cancellation.
I certify that 1 have read this application and state that the above information Is oorrect agree b with an city and county ordkmanoes and state laws relating to bonding
construction, and hereby authorize representatives of this county upon a tlarmed for inspection ptxposes
Signature (Applicant or Agent):
f
Page 2
Application Number
04-00007020
Date 11/05/.04
Qty Unit Charge
Per
Extens-on
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
Permit . . . . . .
WALL/FENCE PERMIT
Additional desc
Permit Fee . . . .
15.00 Plan Check Fee
.00
Issue Date
Valuation . .
. . 80
Qty Unit Charge
Per
Extens_on
BASE FEE
15.00
Special Notes and Comments
POOL & SPA. BBQ ANSI
Z21=58-1995 5 FL 4'
BLOCK WALL CITY STND.
ALARMS/BARRIERS
SHALL BE *IN PLACE PRIOR
TO PREPLASTER
,INSPECTION.
Fee summary Charged
Paid Credited
Due
.Permit Fee Total
297.00 .00 .00
297.00
Plan Check Total
14 2.50 .00 .00
142.50
Grand Total
439.50 .00 .00
439.50