04-7050 (RPL)Tar
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
Application Number
Property Address, . . .. . . .
ABN:
Application description . .
Property Zoning . .. .
Application valuation ...
Owner
------------------------
TORRES DANIEL
DANIEL TORRES
uftmu PM GA 4WOVA CA 99'9219.
y5.405 ,e ,eoo rc CIA 922.53
BUILDING & SAFETY DEPARTMENT
(760).777-701.2
FAX (760) 777-7011.
INSPECTION REQUESTS (760) 777-7153
04-00007050 te..1/03./04
4,5405 DEERBROOK CI
604-4'04-0.1.0-23
POOL - RESIDENTIvv 1 0 �� 4
LOW DENSITY RESID A1'I
20000 CITY OFI
_ AId�EpTA
Contractor
------------------------
POOL SPA CLUB, INC
.36021 CAMPBELL STREET
CATHEDRAL CITY CA 92234
WCC: EVERGREEN INS
WC: 4607284.9000
08/24/05
CSLR: 83354.1
03/•31/'06
CCC: C53
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
9.0000 THOU BLDG
2,001-25,000
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
1.5.00
1.00
9.00.00 EA MECH:FURNACE
<=100K
9.'00
-------------- -------------------------------------------------
Permit . .
. . ELEC POOL PERMIT -RES
------------
Additional desc
.
Permit Fee . .
. . 45.00
Plan Check Fee
3.75_
Issue Date . .
Valuation
0
Qty- Unit
Charge Per
E�tension
BASE;
FEE
.15. 0,0
1.00 30.0000
EA ELEC
PRIVATE SWIMMING POOL
0.00
Permit . . . .
. . PLUMBING
Additional desc
.. .
Permit Fee . .
. . 27.00
P1an.Check Fee
6.75
P.O. Box 1504 VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINT'A, CALIFORNIA 92233 INSPECTIONS (760) 771-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 01q- 7050 Date: R -10-0c/
Applicant:. Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
/A
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S, DECLARATION
1' hereby affirm under penalty of perjury that I -am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division of the Business and Professionals
Code,.and my License is in -full force and effect. $3.3�
/ License Class x"53 ieense No.
,..sata t ni actor
OWNER -BUILDER DECLARATION
I hereby affirm under 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 stnlcture; prior toils issuance, also„rapulfes#w applicant for the permit to file a"signed
statement he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing:rvith:5'ectlon 7000):of Divie(o(f3 of.the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the alleged[exerription..,Any violation 6f Section 1631:5`by any al`ptcari4 for a 00hrit subjects
the.applicantto a civil penalty of not more.than five hundred dollars ($500):):
U I, as owner of the property; or employees wfth wages,as theirsole compensation, will do the work, and the structure is not intended or offered for sale;(Sec: 7044,
Businessand Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improvewtherson, and who does the work
himself or herself or through his or her own employees, provided that the improvements are notintendsd 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 ofiproperty who builds,or'improves thereon, and who contracts for the projects with a contractor(s) licensedpursuant 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=insurefor workers' 'compensation, as provided for by Sectlon'3700 of the Labor Code, for the performance
of the work for which this permit is issued.
1 have and will maintain workers' compensation insurance, as required by'Section 3700 of the tabor Code, for the,perfornance of the work for which this permit is
�
ad. My workers' compensation.' rance.can ier and policy'numqer are:
/Grarier1;e1r5issqqufL;�.1 I r.) S ./Policy Number
_ I certifythat, in the•perfomiance of the work for which this permit is issued, I shall not employ anyperson in any manner so as to become subjectto the workers'
compensation laws of California, an&agree that; If I should become subject to the workers' compensation provisions of Section 3700 ofthe1abor Code .J shall
forthwith comply with those provisions.
1.1
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE'IS UNLAWFUL .AND SHALL -SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE$ 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
thereby affirm underpenaltyof perjury that there is a construction1ending agency for the performance of the work for which,this permit is issued (Sec. 3097, Civ. C.).
Lender's Name k
Lender's Address A
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 requestand 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_cityof La Qulnta, 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 resultof thisapplication becomes null and void if work is not commenced within 160 flys from date of issuance of such permit, or
cessation of work for 1BO days will subject pernR to:cencellation.
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 andstate,laws relating to building
construction, and hereby authorize representatives of this county to enter uponthe.aboye-mentioned property (of Inspecti�onpurposes.
Date gnnature (Applicant or Agent):
S
Application Number . . . . .
Issue Date . . . .
04-0'0007050
Valuation
Page 2
Date 11/03/04.
. 0
Qty
Unit Charge Per
Extension
BASE FEE
15.00
1.00
6.0000. EA
PLB FIXTURE
6.00
1.00
3.0000 EA
PLB WATER INST/ALT/REP
3.00
1.00
3.*0000 EA
PLB GAS PIPE 1-4 OUTLETS
3.0.0
--------------------•---------------------------------------------------------
Special Notes and Comments
POOL ONLY.
ALARMS/ BARRIERS
TO BE IN
PRIOR TO PREPLASTER INSPECTION.
EQUIPMENT
WALL NOT INCLUDED
IN PERMIT.
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Grand Total
Charged Paid
303.00 .00
151.05 .00
4.54.0.5 .00
Credited Due
.00 303.00
.00 151.05
.00 454.05