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05-0883 (RPL)t1ft�Gu BUILDING & SAF.ETY DEPARTMENT 760 777-7012 OF ` 94' �g: CALLE TAMPICO (760),777-70.12 ) FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . �05_O,OD0.088�3 Date 3/15/05 Property Address . . 51133 AVENIDA VALLEJO APN: 773 -062 -017 -6 _000000 - Application description POOL - RESIDENTIAL Property Zoning . . . . . . . COVE RESIDENTIAL Application valuation 15000 Owner Contractor BILL & MAGGIE GORDON MTB INC. ..51133.AVENIDA VALLEJO 50855 WASHINGTON ST STE 149 LA QUINTA CA 92253 LA QUINTA CA 92253 (760) 272-6044 WCC: STATE FUND WC: 1795095-2004 08/01/05 CSLB: 838089 05/31/06 CCC: B Permit . . . MECHANICAL Additional desc Permit Fee 24.00 Plan Check Fee— 6.00 .Issue Date Valuation . . . 0 Qty Unit Charge Per Extension BASE` FEE 115.00 ;1.00 9.0000 EA MECH FURNACE <=100K' 9.•00 Permit BLDG POOL PERMIT Additional desc Permit Fee 162.00 Plan Check Fee 105.30 Issue Date . . . Valuation.'... 15000-. Qty Unit Charge Per Extension BASE FEE 45.00 13.00 9.0000 THOU BLDG 2;001-251000 117._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 P.O. BOX 1504 T • '�C�� 78-495 CALLE TAMPICO 4 LA QUINTA, CALIFORNIA 92253 Application Number: Applicant: Applicant's Mailing Address: BUILDING & SAFETY DEPARTMENT Architect or Engineer: VOICE (760) 777-70.12 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3-16-021 Architect or Engineer's Address: N Lic. No.: BUILDING PERMIT DECLARATIONS 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. icense Classn L. �se No. Date 3 —% —0 ntrmcto, / OWNER -BUILDER DECLARATION I 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 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 1, 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' Slate License Law.). U I am exempt under Sec. , B.& 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 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 issued. M workers' compensation i rance carrier and policy number are: /Carrier �7^'!{ ;A` F J-4/0 /0 -Policy Number ( 7 <-01:1ffi =L oo V _ I certify that, in the performance of the work for which this permit is issued, I shairnot 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, I shall forthwith comply with those provisions. /Date ��✓ an WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE4 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 'l /� Lender's Address N A 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 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 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 enter upon the above -mention o for inspection purposes. ate ��—��Signature (Applicant or Agent): Page 2 Application Number . . . 05-00000883 Date 3/15/'05 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 1-4 OUTLETS 3.00 Special, Notes and.'Comments POOL ONLY WITH SOLAR HEATING. ALARMS/BARRIERS SHALL BE IN PLACE AT J PRE -PLASTER -INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee'summary Charged -Paid Credited Due Permit Fee Total 258.00 .00 .00 25.8.00 Plan Check Total 129.30 .00 .00 129.30' Grand Total 387.30 .00 .00 38.7.30 a