04-7578 (RPL)M
Titf 4 4 a"
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLS TAMPICO . FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number .
. . . . 04-Ob007578 Date
12/02/04,
Property Address . .
. 79620 TOM FAZIO LN N�° "'
APN:
766-031-011-
Application description
. . . POOL - RESIDENTIAL
Property Zoning . . .
. . . . LOW DENSITY RESIDENTIALi),��
Application valuation
. . . . 10000
Owner
Contractor
-----------------------
--------------------
HILL ROBERT M
CALIFORNIA POOLS & SPAS
79620 TOM FAZIO LANE
NORTH P.O. BOX 1280
HOLTVILLE
CA 92250 COACHELLA
*CA 92236
(760) 398-9222
WCC: STATE FUND
WC: 04600061168
01/01/05
CSLB: 656128
10/31/06
CCC: C8 -C27 -C29-053
----------------------------------------------------------------------------
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
15.00
1.00 9.0000
----------------------------------------------------------------------------
EA MECH FURNACE <=100K
9.00
Permit . . . . . .
BLDG POOL PERMIT
Additional desc
Permit Fee . . . .
117.00 Plan Check Fee
76.05
Issue Date . . . .
Valuation . . . .
10000
Qty Unit Charge
Per
Extension
BASE FEE
45.00
8.00 9.0000
-------------------------------------------=--------------------------------
THOU BLDG 2,001-25,000
72:00
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
27.00 Plan Check -Fee
6.75
f•1.. A
P.O. Box 1504 • /:.
w VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
. /L"4
Date:
Architect or Engineer:
Architect or n in 's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
ICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed un pr • -ons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Licer)aq is irtjul4 farce and effect.
License��Claass /C ` b J i rise No. b
Date * /O/'6 Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exe Contractors' State License Law for 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
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 t ' ermit is issued.
I h ve a d will maintain rkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
iss d. worke mpensation insurance carrier glic ej r f
Carrier • Policy N tuber
I certify that, in the performance of the work this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and a that,if should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date Applicant
WARNING: FAILURE TO SECURE WORKERS ENSATION 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.).
Lenders 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 relSeiperformed under or following issuance of this permit'.2. Any permit issued as a result of this application becomes k is of commenced within 180 days from date of issuance of such permit, orcessation of work for 180 days will subject permit to canceI certify that I have read this application and state that the above inf I gree to cgmply with all city and county ordinances and state laws relating to building
constr��-
y authorize representatives of this county t e -mentioned property for inspection purposes.
Date � Signature (Applicant or Agent):
N
0
Page 2
Application Number .
. . . . 04-00007578
Date 12/02/04
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 INST/ALT/REP
3.00
1.00 3.0000
EA PLB
GAS PIPE 1-40UTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
ADDING SPA TO POOL.
Fee summary Charged
-----------------
Paid Credited
Due
----------
Permit Fee Total
----------
213.00
----------
.00 .00
----------
213.00
Plan Check Total
100.05
.00 .00
100.05
Grand Total
313.05
.00 .00
313.05
0
r
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(3) !'rE7 DObM CC'3L"f'ETE SN�-ti AT LEAST TY!'CE DA,_Y fOR SEt'EN DAYS AFTER SHELL S th5i.4r.CED
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(5) e� THAT Al fT+CflG GA'AsD GARAGE OC{aS MEET LOCAL CODES fpi A POOL ENCLOSURE
POTO P?EPLAS!R k"SPfCTfOM
(8) F!tl POE orED!A'ELY AFTER PLASTER tfCliCwk*UCT,3h5__ DC NOT USE A1!8RR u
{� TAKENO CETkAT TNS DRA G IS THE SOLE PROPERTY �'CA R.A POS A D'}? T ANY
USE N91140lT WR.TEN P ' ,CN OF CAUFCA POOLS, INC(S PCHATED BY LJN,
0 R APPRr E5 PLAN POOL. NT �ocATc~s AND HA5QE D E _„PN,?J'ES AWJ NO -CES ACOYE.
51!NA IPE S DATE S!NM M ; POOL PLAN FOR:
NAMEHILL RESIDENCE o
, STREET �7`C2� �N F�t L4ft- md t{
JOB ADDRESS , -x- 'CITY
OFFICE RES
LOTTRACT PAGE BOOK
MAP BOOK PAGE NO. ICITY
t -SS ADDR
CCNJ(RUCTION OFFICE PHONE NO.
SCALE DATE DRAVN BY GH
�41o
SOLD BY,
V
I _ E 1SIQNs DATE
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«------ Q EI- B. /PL A S I f 2 Y
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CONSTRUCTION AUTHORIZATION
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