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05-0996 (RPL)i' T4hf, 4 4 Q" ). BOX 1504 495 CALLE TAMPICO. QUINTA, CALIFORNIA 92253 Atl �.11 ll..QLlVL1 Lumber Property Address . . . APN: Application description Property Zoning . . . . Application valuation . BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).7-77-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 05-000009.96 52405 AVENIDA DIAZ 773-251-018-7 -000000- POOL - RESIDENTIAL COVE RESIDENTIAL 16000 Date 3/18/05 Owner Contractor -- -- --— —-- — — — — — — — — — — —— yi.1 •, 'i, .i • ",e ----- -. }�.---—————— — --- ~� POWER FINANCE PICAZO POOLS & SPAS ' P.O. BOX 134 82365 HIGHWAY 111, SUITE #101 LA QUINTA CA 92253 INDIO CA 92201 (760) 347-5855 WCC: EXEMPT WC: EXEMPT 05/31/05 CSLB: 836900 04/30/06 CCC: C53 ---------------------------------------------------------------------------- Permit . . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 171.00 Plan Check Fee 111.15 Issue Date . . . . Valuation . . . . 16000 Qty Unit Charge Per Extension BASE FEE 45.00 14.00 9.0000 THOU BLDG 2,001-25,000 126.00 ---------------------------------------------------- Permit . . . . . . MECH POOL --------------------- Additional desc Permit Fee . . t. . . j124 00 Plan, Check Fee 6.00 Issue Date Val'uati'on jc s; 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 Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 -----------------------=---------------------------------------------------- Permit . . . . . . PLUMBING Additional desc Permit Fee' 33.00 Plan Check Fee 8.25 r , P.O. Box 1504ICE 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: OS -0996 Date:I Z•Ur Applicant: Applicant's Mailing Address: ©l�I rleA G TO VC Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS IVA 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 Cade, and my License is ' full force and effect. vCicense Class C.• �3� License No. �34.9 4040 Date Contracto/P i C, +0 At 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.). 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.). U 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 acd policy number are: ,{lamer Policy Number c I certify that, in the performance of the work for which this permit is issued, 1 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. ate D f7 Applie�nt "E L; .✓ D P ! IC L O 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. CONSTRUCTIONLENDING 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 !I 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 Quinta, 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 the above-mentioned property for inspection purposes. Da 'te Signature (Applicant or Agent): t Page 2 Application Number . . . . . 05-00000996 `Date 3/18/05 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 PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary ----------------- Charged Paid Credited Due Permit Fee ------------------------------ Total 273.00 .00 .00 ---------- 273.00 Plan Check Total 136.65 .00 .00 136.65 Grand Total 409.65 .00 .00 409.65 r. CJJ/ 10/ LCIC10 10: J7 l bUJ4 f Odd4 t'IUALU UUS I UM HUULS _ _ PAVE 01 vAC.aY�I1610T- NO RCT WALL+ WGW w P waw r ._. _g _ • j _ tnooc ceAC n` - `7NO Lift MM SO ca or, CONDOMM "T Ch OWCOM- PAP Y nmn*Amo= IN - - �-gi -100-inl 5Z �4os Aga. b ,CITYOOIJ,. OUINTA BUILDING & -,' ,'1=TY DEPT. FOR CON ' CRUCTION DA BY fill •� CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS SZ "gp'S- �J� Z_, PERMIT NUMBER OWNER E�ow ��� 12oKS BUILDER Pic, A2.n J To 4S' 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 at building permit. For each applicable trade, all intormation requested below must be completed by applicant. 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