04-7021 (RPL)s BUILDING & SAFETY 'DEPARTMENT
w� P.O. Box .1504
(760).7 77-70.12OF 78-495 CALLE TAMP.ICO FAX (760) 777-7011
ALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 .
BUILDING PERMIT -
NO`v' 08 2004
Ap, lic ,on, Niuj, r 04-0000.7021 Date 11/05/04
. . . 45570 SUNBROOK" LN
AP -IBJ. 604-422-002-10 -23995 -
Application_description POOL. RESIDENTIAL
Property. Zoning LOW DENSITY RESIDENTIAL
Application. valuation 17.000 _
Owner.. Contractor
CIOTA DONALD. V CALIFORNIA POOLS & SPAS
*NOT.ON ;FILE P.0. BOX .1280
UNKNOWN CA 9:999.9 COACHELLA CA 92236`'
.(760) 3.98-92'2.2...
WCC.:. STATE' FUND' -
WC: -
UNDWC:''04.600061165'... 01/01/D5
CSLB:. 65612.8. 10/31/06..
CCC:': C8=C27-C2.9-053
Permit MECH POOL
Additional' desc
Permit Fee . . . . 24.0) Plan Check Fee....6.00 ._-.
Issue .Date Valuation J.
Qty Unit Charge .Per. Extensibz
BASE FEE 1:5:00
1. 0 0. 9.0000 EA.. ME -3H FURNACE < =.1 O O K: 9. 00.1
Permit BLDG -POOL -PERMIT
Additional desc
Permit Fee. 180 OD Plan. Check. Fee 117.0-0'.
Issue Date Valuation 17000
Qty ..Unit. Charge Per Extension
BA�E.FEE 45.00
15.00 9.000.0 THOU BLDG 2,001-25,000 135.00
---------------------------------
Permit ELEC POOL PERMIT. -RES
Additional desc
Permit Fee 45.00 Pian Check Fee 11.25
I'ss•ue Date Valuation .0
Qty •Uni.t.Charge Per Extension
BASE FEE - . .15.00
1.00 30.0000 EA ELEC .PRIVATE .SWIMMING. POOL .: 30.:00.
Permit PLUMBING
Additional desc
Permit Fee 33.0,0 Plan Check Fee ' 8.25
' t
P.O. BOX 1504 �/; .
VOICE (760) 777-7012
78.495 CALLE rAMTICO
FAX (760) 777-7011
LA QUiNTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. _ e-) 7 — 7 p
Applicant:
Applicant's Mailing Address:
Architect or Engineer.
0
Lic. No.:
BUILDING PERMIT DECLARATIONS
Date:
1 herobq afMrtn under LICENSED CONTRACTOR'S DECLARATION
penally of perjury that 1 am icwdwd under Provisions of Chapter 9 (oonnandnp wnh Sedlon 7000) of Divkion 3 d tla'Bu*,m and Professionals
Code, and my Uoensg Is In tme oend effect �� Q
License Class_ L 0
License No.
Date D D co�aador -
1 a
penam
1 hereby aaffirmunder Ny d perjury that OWNER43UMM DECLARATION
CRY or county that requires t commit to ooWtrws m ale wnpl � to , State License Law for the Mowing reason (Sec. 7031.5. Business and Protessbm Code: Any
statement that he or she is icensed ' demollsk or � any ' Prior to its Wasenoe. also requires the appicard for the pemdt b Mie a signed
pursuant b the provisions of the Ca*sftW State Lbense Law (Cfmpter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions ) or that he or she k exempt therefrom and the bests for the alleged O=Vom Any wriole6on d Sediorm 7031.5 by any appiaM for a permit subjects
the applicant b a penalty of not more than Moe hundred dollar (Y500).r
L) 1. as comer Of to property, or my employees with wages as then sob cortpensation, wM do the work, and #0 stnKture is not kmiendea or offered for nab (Sec. 7044.
Business and Professions Code: The Cw*aobrs'State License Law does not appy ban owner d property who bunds or knprvve; thereon, and who does the work
hlrseH or hersa or though his or her own employees. provided that the improvements we not intended or offered for safe, i(.however. the Wgdng or Inproven*nl Is
sob wittili one year Of completion, the owrw4Ader will have the burden of Proving that he or she did not bund or improve for the purpose d sale.).
U 1. as owner of the property, am exclusively contracting with licensed contractors b Construct I* project (Sec. 7044. Business and Professions Code: The Contractors'
State license law does not appy b an owner of property who bunds or Improves thereon, and who oontracts for the projects w 4h a tondractor(s) ieansed pursuant b
the Contractors' Stage License Law.).
U 1 am exempt under Sea _ B.& PSC. for Us reason
Date Owmer_�. _ +`
1 hereby atlnn under WORKERS' COMPENSATION DECLARATION
_ 1 have and.wMmm aIntaln a oe Wlcxt Of b sW for wvorkers' as
d the work for which Us permit is Issued. compensation,a'D ed for by Section 3700'of ihQ Labor Code, for the performance
1 have and win ma(waln workers' compensation insurance, as required by.Section 3700 d the Labor Code, for the pertorarmce d lira work for whidn this permit k
Carrier �P con ensatlon.Usurence carder and pdd� y�m,ber aro: •
Policy Number _ D S/�o�M///e
--1.cerofy that. In the perb!mance d the work for which this pemmlt is issued,) she not employ any person in any manner so as to became subjectlo ee workers'
compensation laws Of C*Wbn a, and agree that, lf1 should become Subject to the wwwkers' compensation provisions of weldor 3700 of the Labor Code. I shall
iorthwith comely met those Provioms.
Date dS J94 '
WARNING: FAILURE TO SECURE WORKERS' C 4PENSATION COVERAGE IS UNLAWFUL, D SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE HUNDRED THOUSAND DMI
DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE- INTEREST, AND ATTORNEY'S FEES.
under
1 hereby affirm ' CONSTRUCTION LENDING AGENCY
Peery d perjury that there Is a construction landing agency for the Performance of the work ler which this permit Is Issued (Sec. 3097. Cly. C.).
Lenders Name
Lenders Address
IMPORTANT Appicatton a hereby made to the Director of B APPLICANT ACKNOWLEDGEMENT
1. Each person upon whose behalf Ids miring and Safety lenNeet b linin
r a pet sub)the condoms and restrictions set lorth on application.issued es o upon
d this a a�� Is made. each person at whose request and for whose bw*M work 1s performed under or pwsm t b any permit
PPlloetiorn, the owner. and the applicant, each agrees to, and shalt, defend, Indemnify and hold harmless the City of Le Q*da. No
2 oM9oeM ageMs and employs" for any act or omission related to the work under or following issummce of Ifs gem IL
Any Permit Issued as a result Of this sppicedw becomes null and void 9Wrtainnenced within 180 days loom date of Issuance of such pwA or
cessation d work ler 180 days will pan -at b u x*Kat(orL
1 cedify that I have read this application and state that the above information is 1 comply with ori dty and county ordinances and state laws relating to hading
construction, and hereby authorize ropresen.Wns of this county to enter upon the Honed property for inspection purposes,
Signature (Applicant of Agent):
Page. 2
Application
Number 04-00007021
Date 11/05/04
Issue Date
Valuation
)
Qty Unit Charge Per
Extension
BASE 'FEE
15.0-D
2.00
6.0000 EA PLB FIXTURE
- 12.00
1.00;
3.00'00 EA PLB WATER INST/ALT/REP
3.09
1.00
3,00.00 EA PLB GAS PIPE 1-4 OUTLETS
3.0oD
Special Notes and Comments,
POOL & SPA.
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 282.00 .00 .00
282.00
Plan -Check
Total 142.50 .' .00 00
142.50
Grand. Total
424.50 .00 00
424.50