05-1022 (RPL)MAR 28 2005
u�l'�ti6v
CITY OF LA QUINTA BUILDING & SAFETY DEPARTMENT
(760).777-7012
OF ft178-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . . .u05-00001022 Date 3/22%05
Property Address . . . . . . 60422 JUNIPER LN
APN: 764-270-999-152 -300232-
Application description POOL - RESIDENTIAL
Property Zoning . . . . . . . MEDIUM HIGH DENSITY RES
Application valuation . . . . 25000
Owner
-------------------------
-ARA
60-422 JUNIPER LANE
LA QUINTA : CA 92253
Contractor
------------------------
BLUE HAVEN POOLS
2318,S. VINEYARD AVENUE (A)
ONTARIO CA 91761
WCC: CLARENDON NATL
WC: 08KR0000891
03/10/06
CSLB: 618892
05/31/05
--------------------------------------------=
CCC: C53
Permit . . . . . .
-----------------------
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
252.00
Plan Check Fee
163.80
Issue Date . . . .
Valuation . . . .
25000
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
23.00 9.0000
---------------------------------------------------------------
THOU BLDG
2,001-25,000
207.00
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
-----------------
Additional desc
Permit Fee
33.00
Plan Check Fee
8.25
P.O. Box 1504• VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 T!t 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: D�_ %!� Date: 3'Z
Applicant:
Applicant's
Applicant's Mailing Address:
pA%Tie,,�7-0f,
Architect or Engineer:
Architect or Engineer's Address:
AIA
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
de, and my License}',s iryfull force and effect.$ $�Z
License Class C: 5 rj License No. `
ate .3-24 Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exem om 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. , 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.
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
iss ed. workers' ompensation insurance came�d poycy_nurpber are:
aa -mer &W li b ooki L Policy Number✓ o g fC KO 000 $41
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.
Date 2 O Applicant
14=
WARNING: FAILURE TO SECURE WORKERS' CO 4
NSATION 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, 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
const ction, and hereby authorize representatives of this county to enter upon above-mentioned property for inspection purposes.
ate Signature (Applicant or Agent).
i
Page 2
Application
Number . . . . . 05-00001022
Date 3/22/05
Issue Date
. . . . Valuation . .
. . 0
Qty Unit
Charge Per
Extension
BASE FEE
15.00
2.00
6.0000 EA PLB FIXTURE
1.2.00
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
7--------------------------
and Comments
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 354.00 .00 .00
----------
354.00
Plan Check
Total 189.30 .00 .00
189.30
Grand Total
543.30 .00 .00
543.30