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04-4626 (RPL)S i 410- n ] 21r v , Y BUILDING & SAFETY DEPARTMENT 1504(760) 777-7012 78-495 CALLS TAMPICO ` FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 Application Number . . . Property Address . . . . APN: Application description Property Zoning . . . . . Application valuation . . BUILDING PERMIT .____04-000 . 04626 ) Date 5/27/04 79883 DEREK ALAN DR 649-630-024-4 -29053 - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 22000 Owner Contractor ------------------------ ------------------------ BRETT JOHN OWNER 79883 DEREK ALAN DRIVE LA QUINTA CA 92253 - -------------- Permit . ------------------------------------------------- . . . BLDG POOL PERMIT ------------ Additional desc Permit Fee . . . . 225.00 Plan Check Fee*. 146.-2.5., Issue Date . . . . Valuation 22000 Expiration Date 11/27/04 Qty Unit Charge Per Extension BASE FEE 45.00 20.00 ------------------------------- 9.0000 THOU BLDG 2,001-25,000 180.00 ------------ Permit . . ... . . MECH POOL --------------------------------- Additional desc Permit Fee . . . . 24.00 Plan Check*Fee 6.00 Issue Date. Valuation . . . . 0 Expiration Date 11/27/04 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 Expiration Date 11/27/04 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 ---------------=------------------------------------------------------------ 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 �l 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: 14 (a9 Date: 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 I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. / License Class 1—__L�c,nse No. Date ctor 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 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.). AgeN (, 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 L w.). U I amempt under Sec. . A P . r t a n Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perj ry one o the following declarations _ I have and will maintai a certific to 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 Iks it 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: Carrier It Policy Number I certify that, in the performa nc of the work for which this pe '1 is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo is, a gree if I should forthwith comply with those p vis on come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall `Date ~ ,` _Oq icant WARNING: FAILURE TO SECURE WOHOUSA COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDREDD DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODST, 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.). Lender's Name 44 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 shall, defend, indemnify and hold harmless the City of La Quints, 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 an1 tion. 1 certify that I have read this application and state that the abov 'nfornabon 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 count o ed to eAy for inspection purposes. atel, 3k �Si hcant or'A ant /� 9 (ApD ,nt or'�. ): i Application Number Permit . . . . . . Additional desc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . Page . . . . . 04-00004626 Date PLUMBING 33.00 Plan Check Fee Valuation . . . . .11/27/04 2 5/27/04 8.25 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.-ALARM/BARRIER SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED. Fee summary Charged ----------------- Paid Credited Due -------------------- Permit Fee Total 327.00 .00 -------------------- .00 327.00 Plan Check Total 171.75 .00 .00. 171.75 Grand Total 498.75 .00 .00 498.75 0 .i 5-! A RE INSC4`N FEE Of $30 WILL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED _ INSPECTION. NO EXCEPTIONS! CiTY G 3. A Qi -','NTA BJILDINC2 `-AFf : Y DEPT. AFS_..7D FUR '