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04-6704 (BLCK)1 'BUILDING.& SAFETY DEPARTMENT P.O.. Box 1504 (700).777-70.12 ��F�►t9� 7.8-49.5 CA OFTK�LLE TAMP.ICO `FAX (760) 777-7011 LA QUINA, CAL,IFOkMA.92253 INSPECTION,,REQUESTS (760) 777-7153 BUILDING: PERMIT Application Number 04-00006704 Date 10/11/04 Property. Address.. 48075 STILLWATER *DR -APN: 658-140-999-108 -29 36 - Application description... WALL/FENCE Property Zoning.. LOW DENSITY RESIDENTIKL Application valuation. . 240 OCT 18 2004 Owner Contractor ---------------- - - CITY -------- -- OF LA_UI A IVANHOE LA QUINTA .COVE N POIAPeF- C/O R _- BARRY MCCOMIC P.O. BOX,.1280 -7979.- IVANHOE. AVE STE 550.' .. COACHELLA CA..,92236 LA JOLLACA' 92037.• (76.0) 398-9222. WCC: STATE FUND. - WC : 04600,061168. 01/01/.05 CSLB.: 656128. 10/31/04. CCC: C8=C277C29-053 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 5 1 00 . 1:00 '9.0000 EA MECH FURNACE.;<=100K 9.00 --------------- .,Permit BLDG POOL PERMIT Additional .desc- Permit .Fee 189.00 Plan Check .Fee 122.85 Issue..Date :. Valuation 1800.0 Qty. Unit Charge, Per Extension BASE FEE 45:00 16:00 9.0000 THOU BLDG 2,001-25,000 144.00 --------_--------- Permit ELEC POOL PERMIT -RES Additional desc Permit Fee 45.00 .Plan. Check: Fee 11.25 Issue Date Valuation. 0 Qty Unit Charge "Per Ext.ension BASE .FEE •15.00. P.O. BOX 1504 • 79-495 CALLE TAMPICO ' CV LA QUINTA, CALIFORNIA 92253• BUILDING do SAFETY DEPARTMENT Application Number. Applicant: 'Applicant's Mailing Address: C YOWE (760) 7.774012 FAX (760) .777-7011 INSPECTION$ (760) 777.7153 Date: . Architect or Engineer. Architect or Engineer's Address: Uc. No.: BUILDING PERMIT DECLARATIONS reby affirm under LICENSED COKRACTOR'S DECLARATION 1 he penalty of pt�y that I am icaised under PvAsions of Chapter 9 (=nmenckp with Section 7000) of Division 3 of the'Business and Professionals Code. and my LlIs in fun foroe and.elfect. Uoense class C--. 53 License No. &Zo 1213 Date D Contractor I lieraby of m'under penalty of perjury VW I am OVTNER43UILDER DECLARATION exempt tram the contractor:' State License law for the blowing reason (sec. 7031.5. Business'and Professions code: Any city or county that requires a.pewhtt b canatfuck alter. kniprove, demoft of. repair any structure, pdor to its Issuance, also s the appicant for the: pewnit b tae a signed statement that he a she is licensed pursuant b the provisions of the Cvft we State License Law (Chapter 9 (camronckhg with Sermon 7000) of DMslon s or the Business and PMkSdons Code) or -that he or sthe.Is exempt theretrow and the basis or the stleged wwmpdm Any Nation of Sectio, 7031.5 by any applicant for a pemnit meas the applicant b a CIA penalty Of not Moro than five hundred dollars (Y500) r U 1, as owner or the aoperty.'or my employeea'wfan wages: as their seta compmwaon. will do to work, alta tie structure k not khtended or offered for sale (Sec >o4s. Buakiess and Professions code The CoiMraetors' Slate uoense Law does not appy b an 0wner01! property who builds or improves thereon, and who does the work himselfor herself or through his or her own OV10yeas. provkledlhat the km)renta vewe.are not Intended prof ed for sate. Ir. howe she bundk,g orkr>pro,�on>bnt la sold within one year of completion, the owner4Ader will have. the ween of proving that he or she did not bund or Improve for tha purpose of sale.). as owner cf the property, am e=kisivoy contracting wlth 8censed contractors b construe the project (Sec, 7044, Business and Professions Code: The Contraston State License Law does not appy b an owner of property who bafids or knprovea thereon, and who contracts for the projects w4W • contractor(s) ioensea pursuant b the Contractors' State License Law.) (� 1 am exempt under Sea'— B.a PA- for this reason Date Owner_ WORKERS' COMPENSATION DECLARATION . 1 hereby affirm under penalty of perjury one of the following declarations:. l.hiave and.wln matritaln a certificate of consent to self -Insure for wortkere compensation, as pmvk%d fol by Section 3700 of the Labor Code. for the perfomiance of the work for which Ws pem* is Issued.. I have and will maintain wpkaW- Cortpensation Insurance, as required by'Seaion 3700 of the Labor Code. for the performance of the work for which this permit is sit fNy rvo rs' cam ensaton.ktsurer4a canter and 9716 oi�,y�y r aro: Cartier. R , Poticy Number D 71.(o/�/Y� //% R I. certify that, in the peAwmance of the work for which this pomit is Issued; l #1100 not employ any person In any manner so as to become subjectb the workers' forcotfi N�m laws of CaOfomia, and agree that 9.1 should became $rgect b the workers' compenaaton provisions of Section 3700 of the Labor Code, 1$1130 comply with those s. Date I) I.i 6 Apptk an WARNING: FAILURE To SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (=100.000). W ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 5706 OF THE LABOR CODE, INTE MID ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 hereby affirm tinder penalty of perjriry that there Is a co CONSTRUCTION lending agency for the performance of the work for which this penNt Is Issued (Sea 3097. CN. C.). Lender's Name. Lender's Address IMPORTANT Application is hereby made to the Director of Builth APPLICANT and Safety for aCKNOWI ACKNOWLEDGEMENT the . nil ety permit subject b the conditions and reatrkiions set forth on this application. 1. Each person upon whose behalf this appticaton 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 ids application, the owner, and the applicant, each +groes b, and shall, defend. Indemnify and hold handess'the City of Le Ciukhta, its ofiioers. agents and employees for any act or omission related to the.iiwork being perbrhed'under or following issuance of this penrlt: 2 Any permit issued as a result of this application becomes null and void If commenced w Wn.lt0 days from date of issuance of such pewit, or cessation of work for 1e0 days will subject'pem,n to cancellation. I certify that I have read this application and state that the above Info non is 1 agree comply with all City and county orduhanoss and state laws.reiating b building construction, and hereby authorize representatives of this county er upon property for Inspection purposes Date 'l� s/ � Signature (Applicant or Agent): 1 4 Page 2 Application Number . . . . . 04-00006704 Date 10/11/04 Qty Unit Charge Per Extension 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 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 -------------------------.--------------------------------------------------- Permit WALL/FENCE PERMIT Additional desc Permit Fee 15.00 Plan Check Fee .00 Issue Date . . . Valuation . . . . 240 Qty" Unit Charge Per Extension ----------------------------------------------------------------------------- BASE FEE 15.00 Special Notes and Comments POOL & SPA. BBQ ANSI Z21-58-1995,ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE'NOT INCLUDED IN PERMIT. Fee summary Charged Paid Credited Due ---------- - ------ ---------- ---------- ---------- ---------.- Permit Fee Total 306.00 .00 .00 306.00 Plan Check Total 148.35 .00 .00 148.35 Grand Total 454..35 .00 ..00 454.35 4