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04-7845 (RPL)D u�l�tr PC'R'Y FLlL►�UIN BUILDING & SAFETY DEPARTMENT 2kg5 `44 9 (760),777-7012 OF 8-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number Property Address' APN: Application description Property Zoning . . . . Application valuation . Owner ------------------------ BOB CHOWNKITE 04-00007845 �6 0 480 LACE _LEAF- CT. _ . � 764-270-999-122 -300231- POOL - RESIDENTIAL MEDIUM HIGH DENSITY RES 18000 Date 12/16/04 Contractor -------7---------------- LOZANO PROF POOL CONST, MIKE P.O. BOX 11272 PALM DESERT CA 92255 (760) 342-7746 WCC: EXEMPT WC: EXEMPT 07/31/05 CSLB: 840397 06/30/06 ------------------------------- CCC: C53 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 . . . .BLDG POOL PERMIT Additional desc Permit Fee 189.00 Plan Check Fee 122.85 Issue Date' .. . . . Valuation 18000 Qty Unit Charge Per Extension BASE FEE 45.00 16.00 ---------------------------------------------------------------------------- 9.0000 THOU BLDG 2,001-25,000 144.00 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 P.O. BOX 1504 78-495 CALLE TAMPICD ' LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Architect or Erigineer: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer's Address: Lic. No. ovlLul"" IrCFCmI I ut ;LAKATIONS 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 my Licee is in full force and effect. en License Class �-_ S 3 License No._ -31'60 4 Date—! .2-- 20' J1' Contractor 0 � �, OWNER$UILDER DECLARATION I hereby affirm under penalty of perjury that I am exemp 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).): (--) 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.). (--) 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 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 issued. My workers' compensation insurance carrier and policy number are: Cartier Policy Number _ 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 Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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. 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.). Lender's Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Buildingand Safetyor a 1. Each person upon whose behalf this application is made, each person at permit request a dto eforwhose benefit work snditions and nperfo s set Erred under or puorth on this rsuant to an 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 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 construction, and hereby authorize representatives of this county to enter upon above-mentioned property for inspection purposes. Date 10 c► Signature (Applicant or Agent): ,�. ' Page 2 Application Number . . . . 04-00007845 Date 12/16/04 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 FLB GAS PIPE 1-4 OUTLETS 3.00 ------------------------------------------------=--------------------------- Spe{cial Notes and Comments POOL & SPA ONLY. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary ----------------- Charged Paid Credited Due Permit Fee -------------------- Total 291.00 ---------- .00 .00 ---------- 291.00 Plan Check Total 148.35- .00 .00 148.35 Grand Total 439.35 .00 .00 439.35 z s 0 P :-,,`'PECTION FEE OF $30 Vu'iLL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. NO EXCEPTIONS! CITY OF', Q UINTA UILDING L& ,rid ETY DEPT. FOR CONS i UCTION ATE BY Cr' t , L�L� CITY OF LA QUINTA SUB -CONTRACTOR LIST 6� G�X04 � % BUILDER ��F� �.ozgr� JOB ADDRESS PERMIT NUMBER OWNER � This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance Df building permit. For each applicable trade, all intormation requested below must be compietea by applicant. --un riie-, is not an acceptaDie response. ''....x ,a:E>.�:;n�; ;'•t'r::'%s"r:'i;'iS i>:;:;: zi5 f`Aii4'e�"r'+�tiY;i;:?iis;:: is::hss;5i;55iG:: i ?i i;? ii ii ?[i ............tti?E'l>rti'nfrAi�trir':C;�r''afi'C7a? ':iii EY2Y2:<?<1A/At'Ira`rCt :` nYYSrYPnCat7Lln.'rnCi'irA�1C? ii2?;??5 [i>i ::f: i : L n L •3 - o Ca � z U r t S � G cue l 1: I;c� S 11 Company Name Classification License Number Exp. Date Carrierr Name Policy Number Exp.. Date License Number . Date ' Exp. - t , B 8 1 9 xxxxxx ( 1 xx xx xx 1 / Fund, C ICom l e. 9 .State Fu d a P Format Va es Varies) 1 xx x x xx / / 1 xx xx 1 x xx xx x / / 1 RTNW:QRICC;:j_:::1:::.;.::::::: Ca Iiit,Ca 1�S Pay t S A.,.. (, -s U v .0 S c .k G� 3 a 3 ./ a CNCR�j .� . 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