04-4693 (RPL)i
ed .4 #'QUb&
BUILDING & SAFETY DEPARTMENT
BOX 1504 (760).777-7012
)5 CALLE TAMPICO FAX (760)'777-7011
UINTA, CALIFORNIA 92253 INS'PECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number 04-0004693 "- Date
Property Address. . . . . 43-6-8-6—PARKWAY-ESPLANADE E
APN: 609-600-0.03- - -
Application description•.. . POOL.'- RESIDENTIAL
Property Zoning.. . . LOW DENSITY RESIDENTIAL
Application valuation 20000
6/01/04
Owner
Contractor
CHRIS CANNON
CONSTRUCTION DtESIGN
SYSTEMS, I
43-686 PARKWAY
ESPLANADE EAST--
78401 HIGHWAY 111, SUITE F-=2 .
LA QUINTA, CA
LA QUINTA
CA 92253
LA QUINTA
CA :92253-
(760) 771-3593
WCC: STATE. FUND
"
WC: 17"0978.5-03
02/01/05
CSLB; '767086
08/31/05
CCC: A' B .
Permit .. . . .
MECH . POOL
Additional desc
.
Permit Fee
.24.00
Plan Check Fbe ..
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
BLDG POOL PERMIT
Additional desc
.
Permit Fee
207.00
Plan Check Fie
134.55
Issue'Date . .
. .
Valuation
20000
Qty Unit Charge `Per Extension
BASE FEE 45.00
18.00 9..0000 THOU BLDG 2,001-25,000 162.00.
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
P.O. 150.4
78-4955 CALLE TAMRICO
LA QUiNTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application NUmber: _ (51y `y ( S
Applicant: e
Applicant's Mailing Address:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
Architect or Engineer.
Architect or Engineer's d
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I herebyaffirm under pen ►y of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and ss Lice a is o furca and effect O
License Class Uoense No. f
Date O Contractog 9UAO_n 611 �af7 �yi(5 ��G
OWNER -BUILDER DECLARATION
I hereby affirmunder penalty of perjury that 1 am exempt from the Contractors' State Uoense Law for the following reason (Sec, 7031.5, Business and Professions Code: Aoy
city or county that requires a permit to construct. alter, improve, demolish, or repair any stnx3um, 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).):
.0 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 Cmntractors' 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 e purpose of sale.). .
(, 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 appy 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 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 self4nsure 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 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 pertdt is
ssu . frsmpensation insurance carrier n r >
Carnet c- p,� PolicyNumber _� -- Z>�j
_ i certify that, in the performance of the work for which this permit'* issued. I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califomi ree that, If I should became subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall
fodhv th cornoly With th _ my t1nna Jl\
WARNING.' FAILURE TO SECURE WORKERS' COMPENSATIOITCOVY4GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700, ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS 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 (Seo. 3097, Civ. C.).
Lenders 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 Qulnta, 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 cormmenoed within 180 days from date of Issuance of such permk, or
cessation of work for 180 days will subject permit to cancelation.
I certify that I have read this application and sta a that the above ornation is correct I agree to comply with all city and county ahimnanoes and state laws relating to building
construction, aandd hereby authorize rep tives of this cou to nter upon ironed property for inspection purposes.
ate KV OI ignature (Applicant or Agent)
c
Page 2
Application -Number
04-00004693
Date 6/01/04
Qty Unit Charge
Per
Extension
1.00 30.0000
EA ELEC.PRIVATE SWIMMING PO -DL
30.00 .
Permit
PLUMBING
Additional desc .
Permit Fee
33.00 Plan Check Fee
8.25
Issue DateL
Valuation
0
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00. 6.00.00
EA PLB FIXTURE
12-.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 & SPA ONLY. -ALARMS BARRIERS SHALL.
BE.IN PLACE PRIOR TO
PREPLASTER
INSPECTION.
Fee summary Charged
Paid Credited-
Due
Permit Fee Total
-309.00 .00 .0D
309.00
Plan Check Total l
160.05- .00 .0D
160.05
Grand Total
469.05 .00 .0-J
469.05
P/L
P/L
e4sting wall
I
bobcat access
lawn
lawn
IN
town
FOUL
1
51 3
TANNING LEDGE
umbrella sleeve
decking,
-patio cover
light switch
�-5-68� �
ZEN
SIE
P/L
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