04-5322 (RPL)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504. (760),777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
r BUILDING PERMIT
Appl�c-amtiori Number . . . . 04-0.0005322 Date 7/01/04
Property Address 53845 AVENIDA DIAZ
APN:. 774 -151 -017 -5 -000000 -
Application description POOL -. RESIDENTIAL
Property Zoning . . . COVE RESIDENTIAL
Application valuation 10000
Owner Contractor
----------- --------- -------=--=----- ------
STEPHEN CORNEY OWNER
53-845 AVENIDA DIAZ
LA QUINTA CA 92553
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 . . BLDG POOL PERMIT
Additional desc
Permit:Fee 117.00 Plan Check Fee 76.'05
Issue Date Valuation 10000
Qty Unit Charge Per Extension
BASE FEE 45.00
8.00 9.0000 THOU BLDG 2,001-25,000 72.00'
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Permit ELEC POOL PERMIT -RES
Additional desc
Permit Fee 45.00 Plan Check Fee 3..75
Issue'Date . . . Valuation . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
.1.00 30.0000 EA- .'ELEC PRIVATE SWIMMING POOL 30.00
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Permit . . . . . PLUMBING
Additional desc
Permit Fee 33.00 Plan Check Fee 8.25
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
Application Number:
Applicant:
• �� VOICE -(760) 777-7012
FAX (760) 777-7011
92253 INSPECTIONS (760)'777-7153
Applicant's Mailing Address:
BUILDING & SAFETY DEPARTMENT
BUILDING PE
I hereby affirm under penalty of pedury that 1 am licensed
Code, and my License is in full force and effect.
License Class -t
Bate
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No..
DECLARATIONS
OR'S DECLARATION
(commencing with Section 7000) of Division 3 of the Business and Professionals
OWNER-BWIDER DECLARATION
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 d com jnsation, 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 s 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 th 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 bu t - 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 wi licensed ntrActors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of erty w ilds r improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am am exempt un r Sec. B.& P.C. f s o
rDate Ow
WO t S'
s: COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declara
I have and will maintain a certificate of consent to self -insure for4uird
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 Section 3700of the Labor Code, far the performance of the work for which this permit is
issed. My workers' compensation insurancecarrier d pol'r are:
CartiQr?f� / Policy Number
certify that, in the performance of the work for wh' permit is ' ued, I shall not employ any person In any manner so as to become subject to the workers'
compen�Otion laws of California, and agree t should be a subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
fbrlth;�6 comply with those provisions.
ate Applicant
WARNING: ILURE TO SECURE WORKERS' COMPENSATIOVCEAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
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
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the oc
1. Each person upon whose.behalf this application is made, each person at whose request and for
issued as a result of this application, the owner, and the applicant, each agrees to, an hall, del
officers, agents and employees for any act or omission related to the work being p ed un
2. Any permit issued as a result of this application becomes null and void if work I comme
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 a comp
construction, and %ereby authorize representatives of this county to enter mentioned ei
Date ` Signature (Applicant or A
jitions and restrictions set forth on this application.
hose benefit work Is performed under or pursuant to any permit
id, indemnity and hold harmless the City of La Quinta, its
or following issuance of this permit.
Othin 180 days from date of issuance of such permit, or
and county ordinances and state laws relating to building
lection purposes.
Page 2
Application
Number .
. . . . 04-00005322
Date 7/01/04
Issue Date
. . . .
Valuation . .
. . 0
Qty Unit
Charge
Per.
Extension
BASE FEE
15.00
2.00
6.0000
EA PLB FIXTURE
12.0.0
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
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Special Notes
and Comments
POOL & SPA,
PERMIT INCLUDES 50LF 6'
GARDEN PER CITY
OF LA
QUINTA STANDARDS.
Fee summary
-----------------
Charged Paid Credited
----------
Due
•Permit Fee
Total
--------------------
219.00 .00 .00
----------
219.00
Plan Check
Total
94.05 .00 .00
94.05
Grand Total
313.05 .00 .00
313.05
CITY OF LA QUINTA
BUILDING & SAFETY. DEPT.
APPROVED
FOR. CONSTRUCTION
(AtodEs
is, .. �, AUICI— CITY OF LA QUINTA SUB—CONTRACT9B LIST
JOB ADDRESSSa,?,--1 `-« D'I►(��L PERMIT NUMBER OWNER --a, BUILDER OL- C
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appe r' g 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 c ply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not. an acceptable response.
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Classification
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Exp. . Date
Carrier Name
Policy Number
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OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law' to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project,, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012ZA
FAX: (760) 77/71_7014A
PROPERTY ADDRESS
PERMIT NUMBER(s)