04-5969 (RPL)O�
• Wei
F BUILDING & SAFETY DEPARTMENT
1504 (760).777-7013
LLE TAMPICO V FAX (760) 777-7011
LA Qu , CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
p�G 2;0
BUILDING PERMIT
�p�aion,Numb.er . . . .
Property Address . . . . .
APN:
Application description .
Property Zoning . . . . . ..
Application valuation
04-00005969 Date
797,88 DECLARATION CT
604-511-019-26 -24.1.97
POOL - RESIDENTIAL
PARKS & RECREAT_ION
2.0000
8/18/04
Owner Contractor
JACK HARRIS BRYAN INVESTMENTS GROUP, INC.
797.8.8 DECLARATION COURT 39301 BADGER STREET, #200
LA QUINTA CA 922'53 PALM DESERT CA 92.21.1
WCC: STATE FUND
WC: 0009,0762003 03/29/05
CSLB: 552140 06/3.0/06
CCC: B;-053
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Permit . . . . . . BLDG POOL PERMIT
Additional desc .
Permit Fee 207.00 Plan Check Fee 134.55
Issue Date . . . . Valuation . . . . 20000
Qty Unit,Charge Per Extension
BASE FEE .45.00
18.00 .9.000:0 THOU BLDG 2,•00.1725,000 162.00
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 .9.00.00•EA MECH FURNACE <=100K 9.00
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Permit . . . . ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . . 4.5.00 Plan Check.Fee 11.2.5
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per
1.00 30.0000 EA
BASE' .FEE
ELEC PRIVATE SWIMMING POOL
Extension
15.00
30.00
P.O. Box 1504 • � VOICE (760) 777-701.2
78-495 CALLS TAMPICO FAX (760) 777-701.1
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 4 59&q Date: 6d o - oq
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's. Address:'
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty 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 my Li is ►► and effect. Ci`—�l c..,! 0
�tioense Class `. cense No. J J I
ra
OWNER-BUILDER.DECLARATION
I hereby affirm under penalty of,pedury that I am exempt from the Contractors' State LicenseLaw for the following reason (Sec. 7031.5, Business and Professions Code: Any
city orcountythat requires aper mit 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 (cornmencing 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 -fora permit subjects
the applicant.to a civil penalty of'nofmore 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
himsetfor herself or through his or her own employees, provided that the improvements are not Intended or offered for sale. If,.however, the buAding or improvement s;
sold within one year of completion, the owner -builder will have the burden of proving,that he;orshwdid not, build or improve for the purpose of sale.).
U I, as owner of the property. am exclusively contracting. with licensed contractors to constructthe 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 RC. for this reason
Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury'one.of:the,following declarations:
_ 1 -have and.wilt 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:
Ite ve 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
S�1sRu�d�AAy pensation'in nce
�
_ I certify that, in the performance of the work for which this permit is issued, I shall not empioyany person in any manner so as to become subject to the workers'
compensation laws otCalifomia, 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.
"110/ �pplicant� A"V
WARNING: FAILURE TOSECURS WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND:SHALL SUBJECT AN EMPLOYER Tp CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION'T07HE'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 there4s. 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 i— A
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictionsset 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 Le Quinta, its
officers, agents and employees for any actor omission,relatedto the work'being performed under or following issuance of this permit.
2: Any permit issued.as a reiuft 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 c tion.
1 certify that I have read this application and state thatthe ab o inform 'on 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 ntyto en r upon the above -me ad property for inspection purposes.
.- V oioSignature (Applicant or Agen G7
i
Page 2
Application Number 04-,00005969 Date 8/18/04
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
Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged.
Permit Fee Total 309.00
Plan Check Total 160.05
Grand Total 469.05
Paid Credited Due
.00 .00 309.00
.00 .00 160.05
.00 .00 46'9.05