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05-1500 (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) 777-7153 BUILDING PERMIT n Number . . . . . 05-00001500 Date 4/21/05 riupciuy iiddress . . . . . . 53664 VIA BELLAGIU APN: 772-510-062- - - Application description POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation_. 18000 Owner. Contractor -------------------------------- --------------------- NISPERO PROP INC CALIFORNIA POOLS & SPAS P 0 BOX 1144 WCC: SEABRIGHT INS LA QUINTA,.CA 92253 WC: BB1050510 01/01"/06 CSLB: 656128 10/31/06 CCC: C8 C27 C29 C53 ---------------------------------------------------=------------------------ U P.O. Box 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: �— �•��Ca I Date �' 3 10 Applicant: Applicant's Mailing Address: (_%f)tv%fermiCTo te Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS NA LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals C e, and my Lice ry4@1isiiir� rce and effect. cense Class `` J cens No -11,6561 ag b3/40gcontractor OWNER -BUILDER DECLARATION 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 for a 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 propeny who builds or improves thereon, and who contracts for the projects with a contractor(s) 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 I 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 a d will maim workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is is Mywor compensation insurance ca�rjr��poJ� nuy� r . / (+� ,,Carver —Policy Numbef ��j (/��0116i[ certify that, in the performance of the work f r which this pe it is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agr if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall /nforthwith comply with those provisions. Applicant WARNING: FAILURE TO SECURE WOR ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND 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 permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address 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. I. 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 k being performed under or following issuance of this permit. .2. Any permit issued as a result of this application becomes null and of if wo 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. I certify that I have read this application and state that the above information is orrect. I gree to comply with all city and county ordinances and state laws relating to building construction, and 76r5_ by authorize representatives of this county t ter u o t abo -mentioned property for inspection purposes. DJe ,' �% Signature (Applicant or Agent): Application Number . . . . . 05-00001500 --------=------------------------------------------------------------------- Permit . . . . . . Additional desc Permit Fee . . . . Issue Date . . . Expiration Date . . BLDG POOL PERMIT iq,*&yK1I67 10/18/05 Plan Check Fee . . 122.85 Valuation . . . . 18000 Qty Unit Charge Per Extension BASE FEE 45.00 16.00 9.0000 ---------------------------- THOU BLDG 2,001-25,000 _------------------------------------------------ 144.00 Permit . . . . . MECH POOL Additional desc'. Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date Valuation . . . . 0 Expiration Date 10/18/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 ---------------------------------------------------------------------------- EA MECH FURNACE <=100K 9.00 Permit . . . . . .' ELEC POOL PERMIT -RES Additional desc Permit Fee 45.00 Plan Check Fee 11.25 Issue Date Valuation . . . 0 Expiration Date 10/18/05 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 Expiration Date 10/18/05 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 Special Notes and Comments POOL & SPA. FIREPIT ANSI# Z-21-58-1995/CGA. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged Paid Credited = Due -- - - - - - - - - - - - - - ---- Permit Fee Total -- - - - - ------ -- - - ------ - - - 291.00 .00 - -- .00 --- - - - - - - 291.00 Plan Check Total 148.35 .00 .00 148.35 Grand Total 439.35 .00 .00 439.35