04-05112 (RPL)P.O. Box .1504
78-495 CALLS TAMPICO .
LA QUINTA, CALIFORNIA 9225.3
BUILDING PERMIT
QUM raj
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number
`=_04-00005112 J Da.t.e_._..6_/2.3_/04
Property Address
_, 776.40 CALLE TEMECU11A
APN:
774-245-012-13 -0.0!0000=�,F
Application description
POOL .-RESIDENTIAL Ir a4.
Property Zoning
.. .. COVE RESIDENTIAL
..Application valuation- .
12000
CITY oFuAQUINT
Owner
FINANCE DEPT.
Contractor
COVE DEVELOPMENT
LEGACY HOMES
54425 AVENI.DA MARTINEZ
:'P.O. BOX 696 .
LA QUINTA' CA: 92253
LA QUINTA :. CA 92.253::
(7 _ _
60) 777 8317'.'
WCC: KNOX INS
WC:' 1576313.
06/01/05
CSLB.: 778280 :...
05/31./:06
CCC: B
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. 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 2,001725,000
90.00
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
15.0'0
.1.00 30.0000 EA
ELEC PRIVATE SWIMMING -POOL
30.00
P.O. BOX 1504 Tvf
78-495 CALLE TAMP" CO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
f�,e•�1 (Tl_
Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
CTI
INSPEONS '(760) 7774153
Architect or Engineer's Ad re
Lic. No.:
BUILDING PERMIT DECLARATIONS
Date:
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
Code, and my License is in full force and effect.
Ubense Class� /_ License No. 1.
Date CCJ Contractor
OWNER43UIL.DER DECLARATION
1 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 of 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 000).):
U 1, 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 properly, am exclusively contracting with licensed contractors to constnx t the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply .) 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 1 am exempt under Sec. . B.B. P.C. for this reason
Date Owner
WORKERS'.COMPENSATION DECLARATION
I hereby affirm under penalty of perjuryone of the following declarations:
_ I have and will maintain a certificate of consent to self4risure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
the work for which this permit is issued.
—I 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
Carrier issued. MY work S compensation insurance carrier aQd�o nymba(are
�(�7?� �t Policy Number / L � /� !j re,
I certiff that, in the performance of the work for which pertNt isIssued, 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, l shall
forthwith comply with those provisions. n
q, -o+-0'
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 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
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 correct 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 er upon the abo tioned roparty for inspection purposes.
Date �a3 Signature (Applicant or Agent
Page 2
Application Number 04-00005112
Date 6/23/04.
Permit- PLUMBING
Additional desc .
Permit Fee . . 27.00 Plan Check Fee
6.75
Issue Date Valuation . .
. . 0
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 6.0000 EA PLB FIXTURE
6.00
1.00 3.0000 EA PLB WATER INS.T/ALT/REP
3.00
1.00 3.0000 EA PLB GAS -PIPE 1-4 OUTLETS
3.00
Special Notes and Comments
POOL"ONLY. 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 231.00 .00 .00
.231.00
Plan Check.Total 111.75 .00 .00
111.75
Grand Total 342.75 .00 .00
r
342.75
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SCALE: NONE
UNAUTHORIZED USE WARNING
FIN SH SALT
THESE DESIGNS ARE THE PROPERTY OF
— — — — — — — — — — — — —
LENCH DESIGN GROUP. REPRODUCTION
— — — — — — — — — WATER LIN
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' IN ANY FORM WITHOUT WRITTEN CONSENT
— —
— — — — — — —
IS EXPRESSLY PROHIBITED. UNAUTHORIZED
USE EXTENDS TO ORIGINAL AND MODIFIED
DERIVATIVE PLANS AND IS APPLICABLE TO
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LONGITUDINAL SECTION
SCALE: NONE
354"
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3 BENCH DETAIL
SCALE: NONE
UNAUTHORIZED USE WARNING
THESE DESIGNS ARE THE PROPERTY OF
LENCH DESIGN GROUP. REPRODUCTION
'
' IN ANY FORM WITHOUT WRITTEN CONSENT
IS EXPRESSLY PROHIBITED. UNAUTHORIZED
USE EXTENDS TO ORIGINAL AND MODIFIED
DERIVATIVE PLANS AND IS APPLICABLE TO
A
" INTENTIONAL AND UNINTENTIONAL
,
INFRINGEMENTS.
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WATER LINE
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DETAIL
SCALE: NONE
A.P.N.: 774-245-012
ADDRESS: 77-640 CALLE TEMECULA
LEGAL: Lor #13, BLOCK 290, UNIT # 25
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