04-4791 (RPL)� _ s
0 Tit of
BUILDING & SAFETY DEPARTMENT
B 504
�- ,.(760).777-70..2
LE TAMPICO
FAX .(760), 777-70. 1
N 1 L!9 fIN CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
�U BUILDING PERMIT
cin of �Epj a
fe�p►acE
App ation Number . . . .. Y-. -040000 1 Date .6./07/04
Property Address . . . . .. �-7=92°91 SIERRA VISTA
APN: 604-440-055-55 -27519 -
Application description . . . POOL - RESIDENTIAL -
Property Zoning . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 15000
Owner Contractor
WITTIG WAYNE POWNER
F -11-1L 51640A ✓o-rA
i3 I
CA 99999-
q27
Permit . . . . BLDG POOL PERMIT
Additional desc
Permit Fee 162.00 Plan Check Fee.*105.34
Issue. Date . . . Valuation . . . 15.004
Qty Unit Charge Per Extension
BASE FEE 45.00
13.00 9.0000 THOU BLDG 2,001-25,000 117.00
Permit . . . . . . MECH POOL
Additional desc
Permit Fee . . . . 24.00 Plan Check Fee.. 6.00
Issue Date . . . . Valuation 0
Qty Unit Charge Per b Extension
,v
BASE FEE x`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 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
1
•
P.O. BOX 1504 _ VOICE (760) 777-7012
LA QUINTA, CALIFORNIAFORN92253 4 4
78-495 CALLE O ��Glw FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:Ll-
7Q Date: �D J -pty
Applicant: I Architect or Engineer: �—
Mpp icani s mailing Address:
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
I herebyaffirm under LICENSED CONTRACTOR'S DECLARATION
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 License is in full force and effect.
License Class License No.
Date' Contractor
I hereby affirm under penaltyof OWNER -BUILDER DECLARATION
perjury that I am exempt from the Contractors,`State License Law for 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 fort 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).):
( j 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 ft 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. , B.8 P.1or this reason
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one It following declarations:
_ I have and will maintain a certir ate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, fort performance
of the work for which this pe it issued.
' c
_ I have and will maintain worke mpensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compen bon insurance carrier and policy number are:
Cartier Policy Number
I cenity that, in the performance of the work for which this permit is issued. I shall not employ an
y person in any compensation laws of California, aro agree that, if I should become subject to the workers' compensation provisionsro of 3700 of t as to be suso come to
Code,the rI shall
forthwith comply with those prov1if(m/
WARNING: FAILURE TO SECURE WORKE S' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOU A DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, IN RST, AND ATTORNEY'S FEES.
I hereby affirm CY
under penalty of perjury that there is a construction lending
agCONSTRency
for tON he LENDING maAGce Of the work for which this
g � � � permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lenders Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
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, indemnity and hold harmless the City of le Quints, 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 applic4cotunt
tin II and void if work is not commenced within 180 dayt from date of issuance of such permit, or
cessation of work for 180 days will subjection.
I certify that I have read this applicatiori and state thattion is correct I agree to comply with all city and county ordinances and state laws relating to building
constructs n, and hereby authorize representatives ofn upon t above-fnentioned property for inspection purposes.
Date ( ignature (Applicant or
Page 2
Application Number 04-00004791
Date 6/07/04
Issue Date . . .
Valuation
.0
Qty Unit Charge Per
Extensicn
BASE
FEE
15.00
2.00 6.000.0 EA PLB
FIXTURE
12.00.
` 1.00 3.0000 EA PLD
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 '
Fee summary. Charged
Paid Credited
Due
Permit Fee Total 264.00
..00 .00
264.00
Plan Check Total 130.80
.00' .00
130.80
Grand Total 394.80
.00 .00
394.80
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CITY OF LA QUINTA SUB-CONTRACTOR LIST
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JOB ADDRESS'
J1�v
PERMIT NUMBER...
OWNER BUILDER
This form shall be costed on the job with the Building
Inspection Card at all times -in a
'bonsaicuou.*, glace. 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 permit. For each applicable trade, all information requested below must be completed by
applicant. "On File' is not. an acceptable response. •
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