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04-5334 (RPL)BUILDING & SAFETY DEPARTMENT Gw4 P.O. Box 1504 (760).777-7012 OF TY�9 78-49$ CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number .. M0=4-0:0:0.0.53.34' Date 7/02/04 Property Address . . . . . 53600 AVENIDA VELASCO APN: 774-124-020-8 -000000- Application description . . . POOL - RESIDENTIAL Property Zoning . . . . . COVE RESIDENTIAL, Application valuation . . . 15000 Owner Contractor -- - - - - - - - - - - - - - -- - - - - - -- ------------------- '--'- STATON CALIFORNIA POOLS & SPAS 53600 AVENIDA VELASCO P.O. BOX 1280, LA QUINTA- CA 92253 COACHELLA CA 92236 (760.) 398-9222 WCC: STATE FUND WC: 04600061168 01/01/05 CSLB: 656128 10/31/04 CCC: C8 -C27 -C29-053 --------------=------------------------------------------------------------- Permit . . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 162.00 Plan Check Fee 105.30 Issue Date . . . . Valuation 15000 Qty Unit Charge Per Extension BASE.FEE 45.00 13.00 9.0000 THOU BLDG 2,001-25,000 117.00 ---------------------------------------------------- ------------------------- 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 Permit Fee 27.00Plan Check Fee 6.75 Issue Date . . . . Valuation ,.-'�, -� 0 Qty Unit Charge Per, x ension BASE FEE � •�, 15.00 1.00 6-.0000 EA PLB FIXTURE O ��' �+r' 6.00 P.O. BOX 1504• ,�. w VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: D L4-5334 Date: Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Licegs�e isjll forca and effect. ! /��/07 cense Class (- > n /License Ifo. 6 \_4* -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I a exempt from tK ontractors' 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 con tractors 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. , B.& 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 I have and will maintai orkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is iss ed. M worke ompensatio urance carrier and p f y num r a : // �arrier Policy Number DO .4 _ I certi y that, in the plerforMance of the work for which thi p i is iss ed, I shall note ploy any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if s o d become ubject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pr>�ions. WARNING: FAILURE TO SECURE WO ERS' COMPEN OVE GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TFfOUSAND DOLLARS ($10teW, N 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. 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 sh fend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being erfo ed unde r following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is of mmenced wi in 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 info ion is correcvi a to comply wit all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county t en r upon the ove- a tioned prop y for inspection purposes. Sre (Applicant or Agent): / Page 2 Application Number 04-00005334 Date '7/02/04 Qty Unit Charge Per Extension 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. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE-PLASTER•INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee summary Charged -- - - - - - - - - -- Paid Credited Due - - - ------ - - - - -- Permit Fee Total 234.00 ---- - - - - -- .00 ---- - - - - -- .00 -----.- - - - -' 234.00 Plan Check Total 123.30 .00 .00 123.30 ^ Grand Total .357.30 .00 .00 357.30