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04-5883 (RPL)ess Ta9v 4 4 a" 1504 kLLE TAMPICO A, CALIFORNIA 92253 r BUILDING PERMIT APN: Application description . . . Property Zoning . . . . . . Application valuation . . . . BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 C04 00-0-0588 Date 8/09/04 79827 DEREK ALAN DR 649-630-048- - - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 17000 Owner Contractor ------------------------ PM RENAISSANCE, LLC ------------------------ CALIFORNIA POOLS & SPAS 9968 HIBERT STREET, STE. 102 P.O. BOX 1280 SAN DIEGO CA 92131 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 . . . . 180.00 Plan Check Fee 117.00- 17.00Issue IssueDate . . . . Valuation 16760 Qty Unit Charge Per Extension BASE FEE 45.00 15.00 9.0000 THOU BLDG 2,001-25,000 . 135.00 -------------------------------------------- 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 BASE FEE 1.00 30.0000 EA ELEC PRIVATE 9NU6 P010 2.1304 ` GITI OF LA QUINTA Extension 15.00 30.00 P.O. Box 1504• �� VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 8 8.3 Date: Applicant: Applicant's Mailing Address: OM� Architect or Engineer: Architect or Engineer's Address: Lic. No.: k) l,A BUILDING PERMIT DECLARATIONS LIC SED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under pro isions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Licen�se{�J�I�II force and effect. r �t Anse Class C.:1 ice set, o. 6� a Date 10Y` Contractor WN R -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 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 1, 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 Owner WORKERS' COMPENSATION DECLARATION .I hereby affirm under penalty of perjury one of the following declarations: _ (,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 maintai workers' compensatio insurance, as required by Section 3700 of the Labor Code. for the performance of the work for which this permit is T' is ed y worke ' compensation i rice carrier _ I certify that, in the performance of the work for which IN peit is is ed, 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 s out beco subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall n forthwith comply with th4proons. Date I 11 cant WARNING: FAILURE TO SECURE WCOMPENSATIONCOVE GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100, 0 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.). Lenders 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 defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being rfrtned un er or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is of :men within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to canc tion. I certify that I have read this application and state that the above inf rim tion is core I a to corn I with all city and county ordinances and state laws relating to building construction, /and hereby authorize representatives of this county en r upon the bove- a tione roparty for inspection purposes. ate ! D `Signature (Applicant or Agent): I Fee summary. Charged ----------------- ---------- Permit Fee Total 297.00 Plan Check Total 142.50 Grand Total 439.50 0 Paid Credited Due ---------- ---------- ---------- .00 .00 297.00 .00 .00 142.50 .00 .00 439.50 Page 2 Application Number . . . . . 04-00005883 Date 8/09/04 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . . A 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 . . . . 240 Qty Unit Charge Per Extension BASE FEE 15.00 ----------------------------------------------------------------------------- Special Notes and Comments POOL/SPA, 15 L.F. 4' GARDEN WALL, CITY STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION Fee summary. Charged ----------------- ---------- Permit Fee Total 297.00 Plan Check Total 142.50 Grand Total 439.50 0 Paid Credited Due ---------- ---------- ---------- .00 .00 297.00 .00 .00 142.50 .00 .00 439.50