04-6831 (RPL).. opo
BUILDING.& SAFETY DEPARTMENT
P.O.. Box 1504 (760).777-70.12
OFT 9 78-495 CALLS TAMPICO `FAX (760) 777-701.1
LA QUINTA, CALIFORNIA.92253 INSPECTION REQUESTS (760) 777-7153 .
BUILDING: PERMIT
Application Number 04-00006831 Date 10/19/C4
Pr.operty.Addre.ss-.. _80.37.5 TORREON WY
..APN: 772-250-997-138 -31349 -
Application description . POOL.- RESIDENTIAL
Property Zoning'.... . . . LOW DENSITY RESIDENTIAL
Application valuation..` 17000
Owner. Contractor'
------------
TOLL CA V CALIFORNIA"POOLS & SPAS - -
C/O KEVIN.D DUERMIT P.O. 80X;1280
'8901 -E MOUNTAIN VIEW. 200.: .. COACHELLA CA .92236.
SCOTTSDALE AZ 85258.. (76.0) 3'9879222..
WCC:' :. ..STATE FUND...
WC: 04600061168 01/01/05.
CSLB:: 65612$ 10/31/04.
CCC: C8 -'C27 -C29-053
Permit MECH POOL
Additional desc
Permit. Fee 24.00 Plan Check*Feb6.00
Issue Date Valuation 0
Qty Unit Charge. :Pe.r Extension
BASE. FEE...... 15 . J 0
1:00 9.0000 EA MECH FURNACE .<---100K 9.D0
--------------
Permit BLDG POOL PERMIT
Additional. desc-.
Permit Feb ". 180.00 Plan Check.Fee� 117. D0
Issue Date. Valua=tion. a 4: 170 D0
Qty Unit 'Charge;. Per �� Extension -
BASE FEE 2 �l!n,f�, . y� i.., 45:00
15:00` •9.0000 THOU BLDG 2,001-25, �""`°
00,,0 L 1.35.00-
-
35.00
----------------------------------------------- ---=------ - - - - -
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
P.O. BOX 1504 e ��
7V�CV VOICE (760) 777.7012
78-495 CALLe TAMtICO : FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
. BUILDING & SAFETY DEPARTMENT
Application Number. _ (D : (cull 3% Date:
Applicant: I Architect or Engineer:
Applicant's Mailing
-Architect or Engineer's
Uc. No.: '
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that 1 am ficerised under provisions of Chapter 9 (commmanoing wtih Section 7000) of Mvlslon 3 of rieBushess and Professionals
Code. and my Lloens is h - forte and.elfecl. // / Q
License Class �-� _V-
4 License No. 65' /2 U
.Date CoimtraLtor . • .
I hereby sffirtn under penalty of perjmay that 1 am OWNER-StitmER DECLARATION
exempt from the contractors' State License Law for to following reason (Sec. 7031.5. Bushess-and Protessiau Code: Any
city or county Wet giros a.psmmit to construct. after. improve. demolish, or.mpalr any structure. prior to its issuance, also requires the applicant for to. file a signed
statOM00t that he sehe r- pursuant to -the Prov(slons
and Professions Coof the Contractors' State License Law (Chapter 9 (commmencing•with section 7000) of Division 3 of the Business
the applicant to a dolt.) or.that he or $he. k exempt therefrom and the basis fortalleged exemption. Any violation of Section 7031.5 by any sppGaimt sora permit subjects
penally of not mora than five hundred dollars (t500).r
(� I.
83 owner of" property.'a my employees with wages; as thele scie compenrtticxt, we do the work, and the structure knot Intended or offered for sale -(Sec. 7044.
Busiiess and Professions Code: The Coft.actore State License Law does" apply b an owner of property who builds or =thereon, and who does time work
soldwithin
hi hese y or ffvo�gof com his a imam own employees, pnovtded that time improvemments :ace not irmtended or offered for sate. If. however. the building or improvement is
sold wAttih one year of oomplefkxm, the owner4 Ader will have the burden of
Pr**V that (, 1. as owner of the property. am excbsi * contracting with kensed contractors OWWA4 0* she did not 7044 or sines for the purpose of sale.) .
State License Law does not apply to an owner of DroJect (Sec 7044. Business and Professions Code: The ContraOtors
the Contractors` State License Law.). Prop "mO lmutlds °f krproves iherson, and who contracts for the projects with a contractor(s) licensed pursuant to
U I am exempt under Sec. B.S PA- for this reason_
Date Owner__
heiebjr affirm under WORKER$' COMPENSATION DECLARATION
D�ky of Dalury One of the following declarations:,
_ I.liof t and.wlp or what a certificate i consent b selfansure for workers' Compensation, as Provided fix by Seclbn 3700 of the Labor Code. iodine perfamanoe
....xof the worts for which penis pertNt is issued..
1have and will maintain wrorkar;' cortpansation insurance, as required bylection 3700 of time Labor Code. far the performance of the work for which this permit Is
MY oro w' don.lrtsurance carrier and poC�r�ymber aro:
Carrier 4-1 a. su.e . , -l Policy Number_
I.cOrtify that. ti the pertortnanca of tha work for which this perrNYis ksued. I shag not employ any person in any manner so as to become subject b the wakens'
forthwith cocompensation lava of Cardomia, and agree that if l should become subject b the workers' compensation provisions of Section 3700 of the Labor Code, l shall
comply with those 3,
l �/ /� .
Date /61 a / b 7 e,N /%.(viii /7/.,
WARNING FAILURE TO SECURE WORKERS, COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS 0100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S FEES.
1 hereby affirm under penalty of perjmiry that there Is a construction lCONSTRUCTION LENDING AGENCY
ending agency for the POdwManoe of the work for which this permit Is Issued (Sec. 3097, Ctv. C.).
Lenders Name
Lenders Address
IMPORTANT Application is her APPLICANT ACKNOWLEDGEMENT
1. Each Person hereby made to the Director of Building and Safety for a permit subject b the conditions and restrictions set forth on this sppticatiori
pe upon whose behalf this epplicatiort is made. each person at whose request and for wtmose benefit work b performed under a pursuant b any permit
Issued as a result of this application, the owner. and the applicant each agrees b, and shall. deterid, IndemnUy and fold harmless the City of La Quanta, its
offcom agents and employees for any actor omission rotated b the.rvork being perfommed-under or
2 mits
Any permit issued as a esatt of this application becomes null and void K not oommonced wttfiint 1 p days from date of Issuen Isssuance of such pertNt, or
cessation of vm* for 180 days YA subjectpermit to cancellation.
1 certifythet 1 have read Ws application end state that the above Information b 1 b comply with sA and
construction, and hereby authorize representatives of this county to er upon the 8onad Property comply
with for county ordinances and state laws.relating to building
/0/z/
% /spection purposes.
Date L of z/ Signature (Applicant or Agent):
Page 2
Application Number
. . . .
04-00006831
Date 10/19/04
Permit Fee-
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
1.00 3.0000
EA PLB
GAS PIPE 1-4 OUTLETS
3.00
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Permit . . .
WALL/FENCE
PERMIT
Additional desc
Permit' Fee
15.00
Plan Check
Fee
..00
Issue Date . . . .
Valuation
. .
. . 80
Qty Unit Charge
Per
Extension.
BASE
FEE
15.00
.Fee summary Charged
Paid Credited
Due
Permit. Fee Total'
297.00
.00
00
297.00
Plan Check Total
142.50
.00
.00
.142.50
Grand Total
439.50
.0.0
.00
439.50
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