05-1042 (RPL)0
V
BUILDING & SAFETY DEPARTMENT
P. x 1504 (760).777-7012
OF �00�8- 95 ALLE TAMPICO FAX (760) 777-7011
cl� Q' NTA, CALIFORNIA .92253 INSPECTION REQUESTS (760) 777-7153
p� z� BUILDING PERMIT
AJ'cation Number . . . . . 05-00001042" Date 3/23/05
Property Address . . . 78405 VIA CALIENTE
APN: 604-032-999-110 -305212-
Application description . . . POOL - RESIDENTIAL
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 38000 i
Owner
AZZU
78405 VIA CALIENTE
LA QUINTA, CA
LA QUINTA CA 92253
Contractor
MASTER POOLS AND SPAS
73555 HIGHWAY 111
PALM DESERT CA 92260
(760) 346-6115
WCC: STATE FUND
WC: 0460014573 07/01/05
CSLB: 238947 03/31/05
CCC: C53
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Permit . . . . . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 336.50 Plan Check Fee 218.73
Issue Date Valuation . . 38000
Qty Unit Charge Per Extension
BASE FEE 252.00
13.00 6.5000 THOU BLDG 25,001-50,000 - 84.50
---'------------------------------------------------------------------------
,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 . . . . . . 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----*--w--=------------------;-----ia------
Additional desc �+
-V
P.O. BOX 1504 • �/
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: CSS- % D `--Z Date:
Applicant:
Applicant's
Applicant's Mailing Address:
Cosi �2/:A C_ Tope
Architect or Engineer:
Architect or Engineer's Address:
IVA
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
pdde, and my License n fu irce and effect. �� jy�
License Class �� Licensee No. b r /�
D tea .�-S Contractor '��6T-r''C �ooL5"E SAW
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 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.).
L) I am exempt under Sec. , BA 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.
K 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
Tissued. My workers' coj�pensation insurance carrier��nnd poli y number are:
arrier S r�TP— CoA///" Policy Number c/ p �1�-Oo/yS�7
_ I certify that, in the performance of the work for which 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 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.
a. tea `2 5�o S Applicant ✓Ll�
WARNING: FAILURE TO SECURE W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED HOUSAND 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
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 enter upon the above-mentioned property for inspection purposes.
a� to 3 _Z S -d 5 Signature (Applicant or Agent): " `
Page 2
Application Number . . . . . 05-00001042
Date 3/23/05
Permit Fee . . . . 30.00 Plan
Check Fee
7..50
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 GAS PIPE 1-4
OUTLETS
3.00
--------------------------------=------------------------------------
Special Notes and Comments
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POOL & SPA. ALARMS/BARRIERS SHALL BE IN
PLACE PRIOR TO PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED IN
PERMIT.
Fee summary Charged Paid
---------------------------
Credited
Due
--------------------
Permit Fee Total 435.50 .00
.00
----------
435.50
Plan Check Total 243.48 .00
.00
243.48
Grand Total 678.98 .00
.00
678.98
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LAND'SGAPE t FURNITURE
FOR ILLUSTRATION ONLY
NOT INCWA= IN CONTRArIT
WITH MASTER POOLS t SPAS
FOOL AREA, 494 S.F. SPA AREA, 5E S.F.
FOOL PERm 8b L.F. SPA PM -= LP.
FOOL FORM, 44 L.F. SPA FORMS 90 L.F.
I:eCK AREA" 104 S.F.
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i405 5P. EXI5TINiS
el0000 CONCRETE TO REMAIN
MASTER I
E -7I' b�i9' BA BOOM I G0H!'�iED PATIO I
CITY ; F 1
& S FETY DE T.
A PRS VE®
FOR ONS RUCTION
AZZU
RESIDENCE
&REAT ROOM
A RE-INATION IFEE OF $30
WILL BE CHOCEED IF I HE APPROVED sem, .
PLANS AND 110 3 CARD ARE NOT ON ml
tuftem
RopKOy -z= T m VIA GA1I1NM LA W1MA
THE SITE TOR A SCHEDULED
NS P E CT I O LOT 110 TR OO= PIMeSH 4 ENTRY
N CE TI NS!
C45TOMM 516NA'R)RE DATE
321/ 4 S