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04-6019 (RPL)Mf BUILDING & SAFETY'DEPARTMEN:T P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-715.3 BUILDING PERMIT Application Number 04-00006019 Date 8/24/04 Property Address 80460-.TORREON-WY APN: v772-250-997-113 -31349 - Application.description . . . POOL - RESIDENTIAL Property Zoning . . . . . LOW DENSITY RESIDENTIAL Appl.i.cation.,valuation.. 1.7000 Owner Contractor TOLL CA V CALIFORNIA POOLS & SPAS C/O KEVIN D DUERMIT P.O: BOX 1280 8901 E MOUNTAIN VIEW. 200.. COACHELLA CA 92236 SCOTI'SDALE AZ 85258 (760) 398'-9222 WCC: STATE FUND WC: 04600061.168 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 6.00 Issue Date Valuation 0 . Qty Unit Charge Per Extens,on BASE FEE 15.00 1:.00 9.0000 EA MECH FURNACE <=I00K 9.00 Permit BLDG POOL PERMIT Additional desc Permit Fee 180.00 Plan Check Fee 117.00 Issue.Date Valuation 17000 Qty Unit Charge Per Extens=on 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 Plari Check Fee 11.25 Issue Date Valuation 0 Qty: Unit"Charge Per. Extension BASE FEE .15.00 P.O. BOX 1504 4 4 �Gc�i� Y VOICE (760) 777-7012 78-495 CALLE CALIFORNIA FAX (760) 777-7011 LA QUINTA, LIFORN92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0 Applicant: I. Applicant's Mailing Address: Date: Architect or Engineer: Architect or Engine is dr s : Lic. No.: BUILDING PERMIT DECLARATIONS LIC NSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under pro i ' of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Lice is in II force and effect. License Class (!!!_5;_ LiceAse o. (O Date 5�1'7,1_kY Contractor TOWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that am exempt from t—, ntractors' 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 for a permit subjects the applicant to 9 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 contractors) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 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 orkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is iss d. yyvorkers' ompensabon insurance carrier a d licy number re: Cartier Policy Number _ certify tha , in the performance of the work for which thi reit is i ued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, jf I ould be co a subject to the workers*..compensafion provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pryG}sions. / Date Z A) WARNING: FAILURE TO SECURE WORAERS' COMP&45ATION 96VE GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($10(,000), ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYEES_ I herebyaffirm under CONSTRUCTION LENDING AGENCY penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.): Lender's Name Lenders Address IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT CA Safety N or APermit subjePt to the CKNOWLEDGEMENT 1. Each person upon whose behalf this application is made, each person at whose request and forwhosewhose benefinditions andt work Is perforstrictions setmed under or orth pulrsuant to an issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Quinta, its permit 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 becomes null and void if work' o menced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct gree to m I with all construction, and hereby authorize representatives of this county t nter upon the bo ntio ed property rt for ins and county ordinances and state laws relating to building P Pe Y inspection purposes. Date 1 /1 ��oy Signature (Applicant or Agent): 3 Page 2 Application Number •. . . . . 04-00006019. Date 8/24/04 Qty Unit Charge Per Extension 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 BASE FEE 15.00 „2.00 6.0000 EA PLB FIXTURE, 12.00 1.00 ' 3.00.00.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 Extension BASE FEE 15.00 Special Notes and Comments POOL & SPA BBQ ANSI Z21-58-1995. FIREPIT 496 AGAL. 5 LF 5' BLOCKWALL 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 142.50 00 .00 142.50 Grand Total 439.50 .00 .00 439.50.