05-0150 (RPL)00
Coil
Fes• ' . � ;. �.
BUILDING & SAFETY DEPARTMENT
1w� P.O. Box 1504 (760)-.777-7012
�
'OF T1 9 84:95 -CA TAMPICo FAX (760) 777-7011
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W LA Q —1N_ . ; riALIFORN'IA 92253 I..NSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
JAN 1NOT
2005 �:.
. .
App aOggNu `00;015'0 Date 1/18/05
Prop— t -y Address . . . 90. -PARKWAY ESPLANADE W
APN:60;9-590-028.-.
Applicati..on descript-ion -POOL' - RESIDENTIAL
Property Zoning ;-: LOW.' -DENSITY RESIDENTIAL
Application val-uation 250'00,
Owner Contractor
------------------------_�'_. ----------=-'-----------
HANOUSEK.`.CAHUILLA POOL CONSTRUCTION INC
79.700 PKWY ESPLANADE " , " P 0 BOX.,25,69
LA QUINTA PALM DESERT CA 92261
LA QUINTA CA 92253. (J60) 360-66`0,2
WCC: STATE' FUND
'WC: 001'0153-2005 01/01/06
.` .CSL,,B:, 692:059 07/31/06
CCC':, C5 3
Permit . . . MECH POOL
Additional desc°.
Permit Fee 24.00- Plan .Check: Feeo 6.00
Issue Date 'Valuation 0
Qty Unit Charge P.er _ Extension
., BASE} FEE < 15.00
1.00 9.0000'EA ` `MECH,FURNACE <=100K 9.00
Permit BLDG POOL PERMIT
Additional desc _
Permit Fee 252.:`00 - 'Pl'ari CY eck Fee 163.80
Issue Date Val ua�tion . . . . 25000
Qty Unit Charge Per Extension
BASE' FEE 45.0-0
23.00- 9.0000`THOU BLDG 21001725,00.0 207.00
-------------------.---------------------------------------------------------
Permit . . . . ELEC POOL PERMIT' -RES
Additional desc
Permit Fee 45% 00 Plan:Check Fee 11.25
Issue.Date Valuation 0
Qty Unit Charge Per 4. Extension
BASE FEE.... 15.00
1.00 30.0000 EA: ELEC PR°I4UATE SWpIMMING POOL 30.00
Permit PLUMBING'
Additional desc
P.O. BOX 1504 • /i .
(N VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT �-1
Application Number: 0.5- - J ro Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
/1h by affirm under penalty of perjury that I am licensed and provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
e, and my Lic,� iZ! '1�rtl d,8ffe/ 9 nO57Qnse Class (tT ( Ii�J (J' cense No. ('� ` I
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that Naxempt fromthe Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to constIter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the per 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 1, 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' 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
d fv�y wo rs' com ensation insurance carrier and ggpp��ic n ber r
Carrier � � � _Policy Number 68 ��Q � �; _ O 5-
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 tha if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisio. )
V Date I �`� licmf= A
WARNING: FAILURE TO SECURE WORKERS' C PENSATION 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
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, indemnity and hold harmless the City of La Ouinta, its
officers, agents and employeesfor 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.
1 certify that I have read this application and state that the above information i correct. I agree to comply with all city and county ordinances and state laws relating to building
jco�nstruction, and hereby authorize representatives of this county to ent r up the above-mentioned property for inspection purposes.
'ware K� S— ignature (Applicant or Age
r
Page 2
Applicaton..Number 05-0000015.0.
Date 1/18/05
Permit Fee 33..00- Plan Check Fee..
8.25
Issue Date . . . . Valuation . .
. . 0
Qty Unit Charge, Per
Extension
,_BASE FEE
15.00 .
2.00 6..0000 EA °PLB, FIXTURE
12.00
' 1.00 3.000.0 EA PLB WATER TNST/ALT/REP-
3.00.
1.00 3..0000 EA PLB- GAS PIPE 1-'4 OUTLETS
3.00
Special Notes and. Comments.'',
POOL, & .SPA. BBQ#Z215~81995'..
ALARMS/BARRIERS`SHALL..BE IN! PLACE rPRIOR'
TO PREPLASTER INSP.ECTION:.EQUIPMENT
ENCLOSURE -NOT INCLUDED IN PERMIT:
Fee summary Charged :'.Paid-, ..Credited
Due
Permit Fee Total 354.00.. .00 ;.00
354.00
Plan Check Total "'189.30 .00 .00,
189.30
Grand Total 543..30 00., .00,
543.30
., ci