04-6663 (RPL).fwQ�rw
BUILDING..& SAFETY DEPARTMENT
O..,BOX 1504 (760).777-70.12
3495 CALLS TAMP.ICO 'FAX (760) 777=7011
LA QUINTA, CALIFOIt141A .92253 INSPECTION REQUESTS (760) 777-7153
BUILDING: PERMIT .
Application Number
04-00006663 Date
10/07/04
PropertyAddre.ss-_.
80390 TORREON WY
. APN:
77.2-25.0=997=106 -31349 -
Application description..
POOL. --:'RESIDENTIAL
Property Zoning*. .
. . LOW DENSITY RESIDENTIAL
Application valuation..':
-17.000
Owner
Contractor
TOLL.CA VCALIFORNIA'POOLS
& SPAS
C/0 (EVIN. D DUERMIT -
P.O.` BOX ..1280
-89,01--E MOUNTAIN VTEW. 200..: ..
COACHELLA CA
.92236
SCOTTSDALE . AZ 85258..
:.. .:(760) 3`98-9222..
W CC•' STATE FUND
WC: '. 04600061168
01/01!05.
..CSLB'.. 656128.
10/31./04-.
--------------------
CCC: C8=C27-C29-053
Permit MECH
POOL"
Additional desc
Permit. Fee
24.00 Plan Check Fee
6. D0
Issue Date
Valuation
0,
Qty Unit Charge.. Per
Extensi�n
BASE-. FEE. - f...
15 . D0
l : QO' 9.. 0000 EA
MECH FURNACE .:<=100K
9'. DO
'Permit BLDG
----------------------------
POOL PERMIT
Additional desc
Permit Fee 180.00,
Plan Check -Fee:.
117. DO.
Issue Date
Valuation
170:)
Qty.. Unit 'Charge ' Per
Extension
...BASE FEE
45.DO.
15:00 9.0000 THOU
BLDG 2,001-25,000
135.30
Permit ELEC
POOL PERMIT -RES
Additional desc
Permit Fee
45.00Plan Check..Fee
11.-25
Is.su6'Date
Valuation
0 .
.0ty Unit Charge Per
Extension
BASE -.FEE-
15.00.
P.O. BOX 1504'tr:.o
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253•
BUILDING & SAFETY DEPARTMENT
Application Number.
Applicant:
Applicant's Mailing Address:
VOICE (766) 777-7012
FAX (760) 777-7011
INSPECTION$ (760) 777-7153-
Date:
77-7153
Date:
Architect or Engineer
Architect or Engineer' 1!s:
"
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED COHTRACTOR'S DECLARATION
I hereby affirm under penalty of pemjrry that I am licensed under provisions of Chapter 9 (commenckp with Section 7000) of Division 3 of t e"Buskess and PNfessionals
Code. and my Licertmis V:3 face and affect.
License Class License No.
Dale% r by ca,aam�a
CWNER-Bt1N.DER DECLARATION
I hereby affirm under penalty of pequry Mat 1 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 pemmlt b Construct, alter. kMrove. demolish, or repair any strumxure, prior to its hsuanca. also requires Nes applicant for the. permit b file a signed
statement sic he or she h icerued pursuant to the provisions of the Contractors' state License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Piofossions Code) Or 213t he a she h exempt the�efrpn and the bash for the alleged exemption. Any violation of Section 7031.5 by any spocant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars (55M).y
U I. as owner of the property, or my employees with wages as their sole oompensaliaon, Will do the work, and Nie structure is riot intended or offered for sat* (Sm 7044. .
Business and Professions Code: The Cattractors' State License Law does not appy to an owner of property who builds or IrMcoves t emon, and who does the work
himself or herself or Nxough his or her own anploy ses, Provided -that the Improvements are not Intended or offered for sate. K however, the budding a krmprovemmbM h
sold within rine year of commpletIM the owner Wader will have fie burden of proving Neat he or she did not hula or krprove for the purpose of sale.)
U I. as owner of the prvpeAy. am eradustvely oontracft with icansed contractors b 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 Nereon, and who contracts for Ne projects with a contactor(s) licensed pursuant to
the Contractors' State License Law.).
U 1 am exempt under Seo. BA PSC. for this mason
Date Owner_
1 hereby affirm under penalty of perjury one of tine tollenWORKERS' COMPENSATION DECLARATION
_ I have and.will maintain a certificate of consent to selff4nsurs for workers'
of the work for which ft permit h Issued.. oonpen as provided for by Section 3700 of ftLabor code. ior Nes performance
I have and will maintain wodwe compensation Insurance, as required by'Secdon 3700 of the Labor Code. for the perfomnance of the work for which this permit Is
Canter 4-f- t i'p wo �. cormRensation-insurance cancer and pd�y�yrt�ber aro:
Poligr Number G 5�(o/7/a/M
I. certify that, In the performance of the work for whshemltsudanot empty any person In any manner so as to become subject b the worfcers'
oortpensation laws of Cafiforinia, and agree that. V.1 should became subject b the waken'Compemisation provisions of Section 3700 of the Labor Code, I shad
bdhwNth comply with those S.
Date 6 G
A
WARNING: FAILURE TO SECURE WORKERS' COfJPENSATION COVERAGE IS UNLAWFUL, AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). W.ADDiTION TO THE COST OF: COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there Is a Construction Lending agency for the performance of the work for which this permit Is Issued (Sac. 3097, CN. C.).
Lender's Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT
Application is hereby made to the Director of Building and Safety for a pertNt subject b the condi8ona and restrictions set torth on this appticatiomi.
1. Each person upon whose behalf this application h 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 b, and shad. defend, indemnify and hold harmless the city of La Oulnta, lta
officers. agents and employees for any ad or omhslon related b the. ortmed under or fodowtng Issuance of this pentyl
2 Any permit issued ass result of this application becorrmes mud and void work is commenced within 180 days from date of Issuance of such peffn or
cessation of work for 180 days will subjectpermit b cancellation.
re
1 certify that 1 have ad this application and state that the above information is 1 b comply with ad city and county ordinances and state laws relating b budding
contrition, and hereby authorize representatives of this county to or tion property for Inspection
Date d 6 Signature (Applicant or Agent):
Page 2
Application Number . . . . 04-00006663 Date 10/07/04
Qty Unit Charge Per Extension
1.00 30.0000 EA, ELEC•PRIVATE SWIMMING.POOL 30.D0
---------------------------------------------- -----------------------------
Permit . . . PLUMBING
Additional desc
Permit Fee . . . . 33.00 Plan,Check Fee 8.25
Issue Date . . . . Valuation . . 0
Qty Unit `Charge Per ExtensiDn
BASE FEE 15.J0
2.00 6.0000 EA PLB.FIXTURE 12.J0
1.00 3.0000 EA PLB WATER INST/ALT/REP •3.D0
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.30
Permit . . . WALL/FENCE PERMIT
Additional desc
a Permit Fee 15.00 Plan Check Fee .00
Issue Date Valuation . . 160
Qty Unit Charge Per Extension
BASE FEE 15.00
-------------------- -----------------------------------------
Special Notes and Comments
POOL & SPA. 10 LF 4 BLOCK WALL CITY
STND. ALARMS.BARRIERS SHALL BE IN PLACE
.PRIOR TO PREPLASTER INSPECTION.
EQUIPMENT.ENCLOSURE NOT INCLUDED IN
PERMIT.
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 .00 .00 439:50
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