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04-5777 (RPL)a, -leaf uw 000 BUILDING & SAFETY DEPARTMENT Br X 15 04(760).777-7012 QUIN `SOF 1pn78�95 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-715.3 BUILDING PERMIT f r - Application Number . . . . . -54-00005777 Date 7/29/'04 Property Address . . . . 77740 CALLE SONORA APN: 773-225-021- - - Application description POOL - RESIDENTIAL Property Zoning . . . COVE RESIDENTIAL Application valuation . . 25000 Owner Contractor POWER FINANCECONTEMPORARY HOMES INCORP P.O. BOX 134. P.O. BOX 1141 LA QUINTA.- CA 92253 LA QUINTA CA 92253, WCC: STATE FUND WC: 167640820.04 07/01/05 CSLB: 736920 03/31/05 CCC: B Permit . . . . BLDG POOL PERMIT Additional desc Permit Fee 252.00 Plan Check Fee 163.80 Issue Date Valuation 25300 ,Qty Unit Charge Per Extension BASE FEE 45,.00 23.00 9.0000'THOU BLDG 2,.•001-25,000 207..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 . . . ELEC POOL PERMIT -RES Additional desc Permit Fee . . . . 45..00 Plan Check Fee 11.25 Issue Date . . . . Valuation . . . 0 Qty Unit Charge Per 1.00 30.0000 EA BASE FEE ELEC PRIVATE SWIMMING POOL Extens=on 15 00 30 00 P.O. Box 1504 • VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: o 4L Applicant: Applicant's Mailing Address: Date: Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS g- 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 C , and License ' in full force and effect. 6 Z Z) icense Class � icense No. OWNER -BUILDER DECLARATION I hereby/aunder 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 cou 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 1, 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. , 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. -6I have 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 i�1nce carrier and y r are: Carrier ol/P icy Number_ / `� Op _ I certify that, in the performance of the work for w�h Gt]Jh it is issued, shall not employ any pers in any manner so as to become subject to the workers' compensation laws of California: an that, if Ishou become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those p ions. W11 WARNING: FYLURE TO SECURE WORRgR-S' COM NS RAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES VP 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.). Lenders Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety fora -it subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each at whos 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 a i ant, each a s to, and shall, defend, indemnify and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omissio elated to the being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null an id 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 ---cell ' n. I certify that I have read this application and state that the above in ation is core construction, a, her y authorize representatives of this coup o enter a as 0 ` Signature (Applicant or Agent): \ nply with all city and property for insp2o state laws relating to building Page 2 Application.Number . . ... . 04-00005777 Date 7/29104 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 3.0000 EA PLB WATER INST/ALT/REPS, 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 354.00 .00 .00 '354.00 Plan Check Total 189.30 .OQ .00 189.30 Grand Total 543.30 .0;0 .00 543.30