04-5779 (RPL)FN
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BUILDING &' SAFETY DEPARTMENT
P.0. BOX 1504 a (760) "777-7012
OFTt9 78-495 :CALLE TAMPICO FAX (760) 777-7011
LA QUiNTA,' CALIFORNIA9.22'53 4N"SPECTION REQUESTS (760) 777-7153
BUILDING}PERMIT,..
Application Number " . 6WO4_' QTQ_0517L719Date 7/29/04
Property Address 435.48'PARK-WAY-75SPLANADE W
APN: _ 609-,590-,021-,. -
Application descrpti.ori..• POOL RESIDENTIAL
Property Zoning... w ;LOW.DENSITY RESIDENTIAL
Application valuation . . . 215'00
Owner Contxacto'r
JOE & JILL WILLIAMS POOL SPA CLUB, INC
3':6021 CAMPBELL STREET
43548 •PARKWAY. ESPLANADE WEST CATHEDRAL CITY CA 92234
LA QUINTA. CA 92'2,53'
WCC: EXEMPT
WC,:', EXEMPT
05/31/05
.CSLB";". 833541.
03/31/06
CCC: C53
Permit
MECH POOL`
Additional desc
Permit Fee
24.00'
Plan,'Check Fee
.6.00
Issue Date
Valuation
0
Qty Unit .Charge
Per
Extension
BP;SE
FEE .,
15.0 0
1.00
9: 000.0. EA MECH
FURNACE <=f00K
9.00
Permit.
BLDG POOL PERMIT
Additional desc
Permit .Fee
225:'010.
Plan, Check Fee
146.25
Issue Date
Valuation
21500
,,.
Qty Unit
Charge Per
Extension
..BASE:FEE-
.45.00
20 . 00 " '9
. 0000 THOU, :.'BLDG,
2•; 0'.0.1-2'S:, 000 ".,
180.00
Permit .
. . ELEC POOL,P.ERMIT=RES
Additional desc
Permit Fee
45:-00
Plan Cheek Fee
11.25
Issue Date
r
VaLuati,on
0
Qty ' Unit
< Per';:'
Extension
,-Charge'
'- BASE .
FEE ` . r :.., .
15. 00
P.O. BOX 1504
"78-495 VOICE (760) 777-7012
CALLS O FAX 760) 777-7011
LA QUINTA, CALIFORNIAFORN92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: O V— ? 7 1? 1 D
Applicant:
Applicant's Mailing Address:
ate.
Architect or Engineer:
- I A
Architect or EJir0±9q Address:.
Lic. No.,
MU1L.UINU F'tKMIT 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 myLi rinse . . iu� force and effect.
License Class_. S J License No.
Date Contractor
0
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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.).
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 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
sued! My workers' c ensation insurance carrier nd policynumber are:
Cartier .L(//'[� �(?7 Policy Num r
_ I certify that, in the performance of the work forich 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 'f I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions// %
Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN AD
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
HALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
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
IMPORTANT Application is hereby made to the Director of Buildin and SaACKNOWLEDGEMENT
IMPORTANT
1. Each person upon whose behalf this application is made, each person atpermit
h s'e request and for to the hose benefit work stions and r�performed under or pus set forth on this rsuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the ork being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void l 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 aboyormafiis w ect I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this couonth a ove-mentioned property for inspection u purposes.
Date Signature (Applicant or Agent): ��
Page 2
Application Number, 0'4-b000577*9
Date -.7/29/04
Qty Unit Charge. Per
Extension
1.00 30"-:0000 EA ELEC .PRIVATE SWIMMING ;POOL
30.00
Permit . . . . . . PLUMBING
Additional desc ;
Permit Fee 33:00 P.lan' .Che ck. Fee
8.25
Issue Date Valuation
0
Qty Unit Charge, Per
Extension
BASE .FEE '...
15. 0;0;:. .
2.00 -6 -..0000 EA PLB F I'XTURE .. ''
12'.00
1.00 3.Q900,EA. PLB.WATER'.INST/ALT%R,EP'
3.00
1.00`T .3,.' °0 0 0'0 EA PLB ' GAS RIPE 1- 4 -OUTLETS
3.00
- - _ -
Special Notes and. Corriments.
- - - - - - - - - - - 7 -
POOL & SPA -ON•LY ,. ALARMS -BAR'RIERS `.SHALL
BE IN PLACE' °P.RIOR �TO PREPLASTER-
INSPECTION: 'EQUIPMENT ENCLOSURE NOT
INCLUDED -IN—PERMIT.
Fee summary.`,: Charged 'Paid Credited
Due
Permit Fee Total 327.00 .00. .0-0`
327.00
Plan Check'TotaCl 171.75 ..00. .00
171.,75
.GranTotal 498.75 .00..:, 00
498.7.5