05-1359 (RPL)BUILDING & SAFETY DEPARTMENT
)x 1504 (760).777-7012
CALLS TAMPICO FAX (760) 777-7011
NTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
r . . .
APN: .
Application description
Property Zoning . . . . .
Application valuation
Owner
IVANHOE LA QUINTA COVE
C/O R BARRY MCCOMIC
7979 IVANHOE AVE STE 550
LA JOLLA CA 92037
05-00001359 Date 4/11/05
47865 STILLWATER DR
658-140-999-57 29436 -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
18000
Contractor
CALIFORNIA POOLS & SPAS
P.O. BOX 1280
COACHELLA CA 92236
(760) 398-9222
WCC: SEABRIGHT INS
WC:, BB1050510. 01/01/06
CSLB: 656128 10/31/06
CCC: C8* C27 C29 C53
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Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Fee 189.00 Plan Check Fee 122.85
Issue Date Valuation 18000
Qty Unit Charge Per Extension
BASE FEE 45.00
16.00 9.0000 THOU BLDG 2,001-25,000 144.00
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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
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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
P.O. BOX 1504 • '���
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: U
Applicant:
-13
Applicant's Mailing Address:
DtV T69G7V
I hereby affirm under penalty of perjury that I am licensed
ode, and my Li e i'7t5"' fuf orce and effect.
License Class
Date LlIldos- Contractor
Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
. Date: 12_ -0_�—
Architect or Engineer's Address:
Lic. No.:
tSUILUING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
)e No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt fr a Contractors' State License Law foi 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 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 whit his permit is issued.
"sve d will maim workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
worl � compensation insurance cam r i r e�^ ///
Carrier Policy Nu er ri lLl6L-
(certify that, in the performance of the work for hich this permit is issued, I shall not em y any person in any manner so as to become subject to the workers'
compensation laws of California, and agree should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
/� %
forthwith comply with those pro 'sions.
a'D to Applican
WARNING: FAILURE TO SECURE WORKIfRS' CON't4SA.P6N 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 „ /r9
V 7
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Bjilding 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 Quinta, 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 v 'd 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 i orrec I agree to comply with all city and county ordinances and state laws relating to building
construction nd h reby authorize representatives of this county to enter up thea ve-mentioned property for inspection purposes.
Date � nature Si A
9 (Applicant or Agent):
Page 2
Application
Number . . . . . 05-00001359
Date 4/11/05
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/REP
3.00
1.00
3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
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Special Notes. and Comments
POOL & SPA.
ALARMS/BARRIERS SHALL BE IN
PLACE PRIOR -TO
PRE -PLASTER INSPECTION.
EQUIPMENT.ENCLOSURE NOT INCLUDED IN
PERMIT.
;... Fee summary
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Charged Paid Credited
----------
Due
Permit Fee
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Total 291.00 .00 .00
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291.00
Plan Check
Total 148.35 .00 .00
148.35
Grand Total
439.35 .00 .00
439.35