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05-1499 (RPL)GC4P " z v � _ BUILDING & SAFETY DEPARTMENT P.O. Box 1504 c�ti1OF 78-495 CALLE TAMPICO (760).77.7-7012 (760) 777-7011 A QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 D BUILDING PERMIT Ap Number . . . . 05-00001499 Date 4/21/05 Address . . . . . . 53696 VIA BELLAGIO AP 772-510-061- - - pplication description POOL - RESIDENTIAL Property.Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . 18000 Owner Contractor HILL ROBERT M CALIFORNIA POOLS & SPAS 79620 TOM FAZIO LANE NORTH WCC: SEABRIGHT INS HOLTVILLE, CA 92250 WC: BB1050510 01/01/06 CSLB: 656128 10/31/06 CCC: C8 C27 C29 C53 --------------------------=------------------------------------------------- f P.O. BOX 1504 n1�r1Y 78-495 CALLS T,AMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA VOICE (760) 777-7012 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0_. — / 9 Date: Applicant: I Architect or Engineer: Applicant's Mailing Address: 60 Al TAP,40 Tole Architect or Engineer's Address:, Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty cf perjury that I am license , r provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Lice isy�! 11 force and effect. ! �/ 19 License ClaZ �(+—S Lice e No. () 61 2 ✓ Date QJJ Contractor L 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 property 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 cf 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 Xof the work for which this permit is issued. _ I have and will mainta' orkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is iss4Ay worky compensation insurance carne nd ppII'}'ccyy Carrier Policy Number �nG//[�L certi y t at, in the performance of the work for which tWper%?I`is7issued–.I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California. and agree at, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 'Date d3las._ Applicant R WARNING: FAILURE TO SECURE WORKE' COM ION 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 Q Lender's Address ILI✓ r 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. 1. 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 work performed under or following issuance of this permit. .2. Any permit issued as a result of this application becomes null and void if ork is t 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 corr ct. gre to comply with all city and county ordinances and state laws relating to building construction. and hereby authorize representatives of this county to e poen the bove- ntioned property for inspection purposes. Date 6�! dS ^ Signature (Applicant or Agen-,). / .----------+----------------------------------------------------------------- A lication Number ---------------------------------------------------------------------------- . . . 05-00001499 Permit . . . . . . BLDG POOL PERMIT. Additional desc Permit Fee . . . . 189.00 Plan Check Fee 122.85 Issue Date . . . . Valuation . . . . 18000 Expiration Date 10/18/05 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 -------------------------------------7-------------------------------------- EA MECH FURNACE <=100K 9.00 Permit ELEC POOL PERMIT -RES Additional desc Permit Fee . . . . 45.00 Plan Check Fee 11.25 IssueiDate 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 #Z21-58-1995/CGA. ALARMS/BARRIERS SHALL BE IN:PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. i 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