04-8116 (RPL)a"
BUILDING ?& SAFETY DEPARTMENT
P.O'B'ox 1504 _ (760) 777-7012
:-78-495 'CALLE tKMy PICo FAX (760) 777-7011
LA QuINTA;`CALIFORNIA- 92253 INSRECTION. REQUESTS (760) 777-7153
BUILDIN;G`PERMIT.
"Application Number . .
40 4 0>0•0.0-8;11.6 Date
1/28/05
Property;Address43565
PARKWAY ESPLANADE W
APN:.020..-_.
`POOL
Application description.
R=ESIDENTIAL
Property Zoning;.'..
I,OW DENS1TY `:RESIDENTIAL
t
Applicaion' va1Lia t tion
_ 17000
Owner
Contractor:
PONDEROSA HOMES"II, LLC
CALIFORNIA POOLS & SPAS
400 S. F.ARRELL...,DRIVE::
`', 03 P.BOX :<12'80
PALM .SPRINGS, 'CA: 9226
6 ACH.ELLA' �: CA
92236
LA QUINTA
92- 3 :' r 60), 398'-=92'22
FEB O ZOOS CC SEABRIGHT INS
C BB1050:510
01/01/06
CIY1'®F1,�i`�d91B�T� SLB :. 6.5 6.1,28:
10/31/06
P1N�fl9CaDEP,;. CC:. C -8. -'C27 -C29-053
Permit . . . : ' . tLDG POOL .PERMTT
Additional desc
Permit Fee
" 180..'00 Plan -Check' Fee
117.00
Issue Date
;:Valuation . . . .
17000
Qty Unit Charge,..
Per'
Extension
BASE FEE
45.00
15.00. 9. 0000
THOU;, BLDG 2;•',001T'25, 0.0,0
135.00
-------------...- ---:-----
Permit
-.- --- ;-:--.-------- ------------------------------
MECH POOL
Additional desc
Permit Fee
2.4 00 -P1 -an Check Fee
6.00
Issue.,Da,te
"Valuations
0
Qty Unit:,Charge
:Per
Extension
`BASE,'* °FEE-
15.00
1.00` "6' '9. 0000
-: EA MECH FURNACE.<=100K
9.00
Permit . . . . .
ELEC POOL PERMIT -RES
1 Additional desc
Permit Fee
45.`00,,, P1a'nb*Check..•Fee
11.25
Is -sue -Date-
Va`lua.tidn'
0
Qty :.;Unit Charge
_'-Per'
Extension
BASE 'FEE .,
15.00
1.00 3.0:0000_
EA ELE•C` PRIVATE' SWIMMING .-POOL
30.00
Permit
PLUMBING'`
Additional desc
P.O. BOX 1504
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
n
Applicant's Mailing Address: Vo
Date: ,Z • 1.05-
Architect or Engineer:
Architect or Engineer's Add ess:
Lic. No.:
tsUILUING 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 ss Licer3se>is
1/License Class
and effect. /' /
ss C , 5,3� ce a No. !� iW -?g
ate 0610,E ✓Contractor
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 rive 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 1 am exempt under Sec. , B.& 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.
1 ha v and will mainWn workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
e . y wo compensation insurance carrierprr DOIi naum�ber arr�tt'
rtier cS Policy Number _!�U (p ��
I certify that, in the performance of the work for wh' h this perm is issued. I shall not emp%loyany person in any manner so as to become subject to the workers'
compensation laws of California, and agree th , uld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
�'
forthwith complywith those pro 'sions.
i�a1e `'%, 015'—
f–4(pplicant
WARNING: FAILURE TO SECURE WO ERS'COMPEN1WTftN 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.).
Lender's Name
Lenders 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 be'ng performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if wo is 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 torr I a ree t comply with all city and county ordinances and state laws relating to building
4at
constructio/n,,, and hereby authorize representatives of this coun to ter upon ab v n ' ned property for inspection purposes.
�` 161-5 Signature (Applicant or Ager
.... t I 4�5i�.... •.. ....F: f'V :,, i/. 'M,„br vY.•S _
.r: ._ ..-iNs:
Page 2
Application_ Number- 04-00008il6-`' E.
Date 1/28/05
Permit Fee 33'.0.0 Plan Chedk Fee
8.25
Issue Date v1-uation,:•
0
Qty. Unit Charge Per
-Extension
BASE FEE' :.
15.0 0
2.00 6.0:0 0 0 'EA •PLB FIXTURE.
12.00
1.00 3 :•00`00 EA " . PLB.`'WATER INST/ALT/REP'
3.00
1.00 3.0000 EA -PLB GAS..PIPE`1-4 Q.UTLETS
3.00
Special. Notes;, and Comments "
POOL/SPA..` "ALARMS/:BARR.`IERS .SHALL -BE •IN.
PLACE AT PRE -PLASTER INSPECTION.:
EQUIPMENT'.ENCLOSURE.NOT`INCLUDED
Fee summary Charged Paid Credited
Due
Permit Fee•Total .2'82.00 .00 .00
282.00
Plan -Check Tota=l 142!.;50 %.00 00.,
142.50
Grand Total: 424:''5.0° .00 .00
424.50