04-6479 (RPL)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 ' (760).777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number '. &-4-0000647' Date 9/28/04
Property Address . . . . . . 56440 JACK NICKLAUS
APN: 762-070-034- - -
Application description POOL - RESIDENTIAL
Property Zoning . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . 18000
Owner Contractor
------------------------ ------------------------
LEE CALIFORNIA POOLS & SPAS
56440 JACK NICKLAUS BLV P.O. BOX 1280
LA QUINTA CA 92253 COACHELLA CA 92236
(760) 398-9222
WCC: STATE FUND
WC: 04600061168 01/01/05
CSLB: 656128 10/31/04
CCC: C8 -C27 -C29-053
----------------------------------------------------------------------------
Permit BLDG POOL PERMIT
Additional desc
Permit Fee . . . . 189.00 Plan Check Fee 122.85
_Issue Date Valuation . . . . 17892
Qty Unit Charge Per Extension
BASE FEE 45.00
16.00 a 9.0000 THOU BLDG 2,001-25,000 144.00
----------------------------------------------------------------------------
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' -,R, S
Additional desc
Permit Fee 45.00 P0ln Check Fee 11.25
Issue Date . . . . Val-uati�on . . . . 0
Qty' Unit Charge Per0 06, Extension
BASE FEE�q� 491 15.00
1.00 30.0000 EA ELEC PRIVATE„OS=WIMMING�OOL 30.00
P.O.BOx 1504 'G`��/� ,
78-495 CALLS TAMPICO w VOICE (760) 7'i-7(11:
LA QUINTA, CALIFORNIA 92253 4 4 FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: - 7Date: _ /0-6 .0 V
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
A) 1A
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed un rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Cede, and ss Lik-- — c in II force and effect.
/License Class l.. icen a No.
7�
Date Ab ntractor
I herebyaffirm under �J OWNER -BUILDER DECLARATION
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 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 Professio
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contns Code: The Contractors'
ractors) 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 self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
.2aof the work for which this permit is issued.
havq and will maint 'n workers' compensation insurance, as required by Section 3700 f t e Labor Code, for the performance of the work for which this permit is
s y work ' compensati ' urance carter n� yoI' u r /'
arrier S Policy Number �yjy��pf (s
_ I certify that, in the performance of the work for which }his it 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, -Fr
t/1 ould me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those proviOgns. % f
Date 0/(�
WARNING: FAILURE TO SECURE WORK S' COMPENSATIOfT-�RAGE 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.
I herebyaffirm under CONSTRUCTION LENDING AGENCY
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.).
Lenders Name
Lenders Address
APPLICANT
ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Buildingand Safety ty Apermit 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 perforated under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each ag o, 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 wo ing erfomted under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void i work is t commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
jr
I certify that I have read this application and state that the above information is I gree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this count enter upon abo e --mentioned property for inspection purposes.
V6
D,ate Sign plicant or Agent)
J
I
Page 2
Application Number . . . . . 04-00006479
------------------------------------------------------------=----------------
Date 9/28/04
Permit . . . . PLUMBING
Additional desc
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 3.0000 EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00'
Permit . . . . . . WALL/FENCE PERMIT
-----------
Additional desc
Permit Fee 15.00 Plan Check Fee_.
.00
Issue Date . . .`. Valuation . .
. . 108
Qty" Unit Charge Per
Extension
BASE FEE
----------------------------------------------------------------------------
15.00
Special Notes and Comments
POOL/SPA, 5 L.F. 5' EQUIPMENT SCREEN
WALL, CITY STANDARD. ALARMS/BARRIERS
SHALL BE IN PLACE AT PRE -PLASTER
INSPECTION.
Fee summary Charged Paid Credited
-- - - - - - - - - - - - - - -
Due
----- - - - - ------ - - - - ------ - - - - --
Permit Fee Total 306.00 .00 .00
---- - - - - --
306.00
Plan Check Total 148.35 .00 .00
148.35
Grand Total 454.35 .00 .00
^ J
454.35
J
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