04-6877 (RPL)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLS TAMPICO FAX (760).777-7011
LA QUINTA, CALIFORNIA 92253 .INSPECTION REQUESTS (760) 777-7153
Qty Unit Charge Per Extension
BASE FEE 15.00
BUILDING PERMIT
Application Number ..
. . . .._04-00006877 Date 10/22/04
Property Address
. . . 53890 AVENIDA VELASCO
APN:
774 -165 -008 -9 -000.000 -
Application description
. . . POOL = RESIDENTIAL i
COVE
Property Zoning . . .
. ... RESIDENTIAL
Application valuation.. 12000 ,
{ �
-,EC 142004 V
Owner
Contractor _
_ �
------------------------
------------------z.-iYu'
SABALA LUIS OWNER
53-R90A0E 11ELA5C4
E
A� qulAJrA
CA -9- 9
.q 2253
Permit
BLDG POOL PERMIT
Additional desc'.
Permit Fee
135.00 Plan Check Fee.
87.75
'Issue Date . . . .
Valuation . . .
. 12000
Qty Unit Charge
Per
Extension
BASE FEE
45.00
10.00 9..0000
THOU BLDG 2,001-25,0.00
90.00
Permit . . . . .
MECH POOL
Additional desc
Permit Fee
.24.00 Plan Check Fee
6.00
Issue Date
Valuation . . .
. 0
Qty Unit Charge.
Per
Extension
BASE FEE
15.00
1.00 9.0000
----------- ---------- -------------------------------------
EA MECH FURNACE <=100K
9.00"
Permit . ... . . .
- ------==-------a--
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
33.00 Plan Check Fee
8.25
Issue Date
Valuation
0
Qty Unit Charge Per Extension
BASE FEE 15.00
P.O. BOX 1504 • ��IIG�
li7 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92.253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Date: /Z- /4�- 0
Architect or Engineer:
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 70001 of Division 3 of the Business and Professionals
Code, and my License is in full force and effect.
License Class License No.
Date Contractor
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.).
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. fohis reason
U01 --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 ave and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
;-arrier Policy Number
I certify that, in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California, and agree that. if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions,
WARNING: FAILURE TO SECURE WORK S' COMPEN'S*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 Ch
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 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 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 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 rrect. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter upo the above-mentioned property for inspection purposes.
Pate / ignature (Applicant or Agent):
Page 2
Application Number 04-00006877
Date 10/22/04 r
Qty. Unit Charge Per
Extension
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. ALARMS/BARRIERS SHALL
BE IN,
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary -.Charged
Paid
Credited
Due
Permit Fee Total 237.00
.00-
.00
237.00.1
Plan Check Total 113.25
.00
.00
113.25•
Grand Total 350..25
.00
.00
350.25
Y
1
PRAWN.
CMSCKKO
DATt
8CALM
JO• NO.'
•MSST
OR KMKET� .
Of LA QUINTA SUB—CONTRACTOR LIST
JOB ADDRESS 5.3
WCITY
oto'"EJtDA V&LA56D
PERMIT NUMBER OWNER LUIS -W,4619 BUILDER—
This form shall be posted on the job with the Building
Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of -work and/or the voidance
of building ermit. For each applicable trade, all information requested below must be completed by
applicant. "On File" is not an acceptable response.
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Classification
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License Num
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Date
xx/xx xx1
C"rName
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•Polic Number
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Exp. Date
(XX XX XX
LicenseNu mber
(XXXX1
Ex . Date
(XX XX/xx )
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