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04-6634 (RPL)t o a � 5 BUILDING & SAFETY DEPARTMENT P.O.. Box 1504 (760).777-70.12 OF9 78-495 CALLS TAMP.ICo FAX (760) 777=7011 LA QUIN'PA, CALIFORNIA.922.53 INSPECTION REQUESTS (760) 777-7153 BUILDING. PERMIT Application Number 04-00006634 Date 10/05/04 Property .Addre,ss -- 51333 EL DORADO' DR. -APN: 772-250-996-182 -31349 - Application description . POOL. RESIDENTIAL Property_Zoning'. LOW DENSITY RESIDENTIAL .Application valuation. ' 18.000 Owner. Contractor TOLL CA V CALIFORNIA POOLS & SPAS C/O KEVIN.D DUERMIT P.O. BOX.1280 -8901.E MOUNTAIN VIEW 200- COACHELLA CA .92236, 'SCOTTSDALE AZ 85258..(760) 398-9222. WCC : STATE FUND... WCc 04600061168 91/01/05 CSLB; 6.56128 10/31/04. CCC: C8'C27-C29-053 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.Q0 9. 0000 ,EA MECH FURNACE ::<=1.00K 9.00 Permit BLDG POOL PERMIT Additional.desc Permit.Fee 189.00 Plan Check.-Fee, 122.85 Issue.Date Valuation 18000 Qty. Unit Charge Per Extension BASE FEE 45:00 16.00 .940000 THOU BLDG 2,001-25,000 144.00' Permit ELEC POOL PERMIT=RES Additional desc Permit Fee 45.00 Plan Check Fee 1.1.25 Issue DateValuatiori - 0 Qty Unit Charge Per �,,� Extension BASE . FEE' �" "' 15.00 P.O. BOX 1504 cu. 78.495 CALLE TAMPiCO :..• LA QUINTA, CALIFORNIA 92253 Application Number. Applicant: Applicant's Mailing Address: BUILDING & SAFETY DEPARTMENT Architect or Engineer: Architect or Uc. No.: J ff VOICE (766) 7.77-7012 : FAX (7 60) 777-7011 INSPECTIONS (760) 777-7153 BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby eRtrtn undeerr penalty of pe" that I am kmised under provisions /of Chapter 9 (commencing with Section 7000) of Division 3 at the Business acid Pioiessbnals Code. and uoense Class lJdx L S3 focoe and effect..License No. &Z 1213 DateD 4o lev Contractor • a4A OWNER$UU.DER DECLARATION I hereby.atfinnunder penalty nt per)ury that 1 am exampt from the Contractors' State Lioense Law for tis ft4owkV mason (Seo. 7031.6. Business and Professions Code: Any city or county that mores a pemhk to constrict, alter, improve. demolish, or repair any structure, pior to its krsuanoe, also mquima the applicant for fie. permit to fde a signed statement that he or she Is 116ansed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (meg with Section 7000) of Division 3 of the Business and Professions Coge) or -that he or she.le exempt themtrom and the best ler the alleged exemption. Any violation of Section 7031.6 by any appikeiht lora PVn* subjects the applicant to a civil. penalty of not more than five hundred dollars ($500).r U I. as owner of tib property, or my employees with wages as their sole Compensation, will do to work, and the structum is not intended or offered for sale (Seo. 7044, Business and Professions Code: The Cm* aetore State License Law does not apply b on owner of property who builds at impeoves thereon, and who does to work himself or herself or through his or her own employees. provided -that ft Improvements are not intended or ofted for safe. If. however, the building or i mprovembnt Is sold within oyear of completion, the owner4x0der will have "burden of povkng fiat hb ar she did not build or krprove for the purpose of sale.). (� 1. as owner of tine e property. am ex fWyely contracting with 11m sed contractors b construct the.p ajeet (Sec 7044. Business and Professions Code: The Contras' . State License Law does not appy to an owner of property who builds or improves thereon, and who contracts br the projects with a contractor(s) licensed pursuant to the Contractors` State License Low.). V I am exempt under Sea . BA PA. for this reason Date Owner, •; ._ WORKERS' COMPENSATION DECLARATION 1 hefetry affirm under penalty of pw)ury one of the following declarations:, _ I have andmill maintain a Certificate of consent to selfansure for workers' con nsad m, as provided for by $action 3700 of the Labor Code. for the performanceY. of the work for which this permit is Issued. . 1 -haw and will maintain workers' compensation insurance, as required by'Secton 3700 of the labor Code, for the perbrmance of the work for which this per it Is MYsation.Insurance canter and ram: Carrier 4-1- b'i'R A., .f. Policy Number I,oertiry that; to the performance of the work far which Ws pemhit isIssued, l shall not employ anyperson In any manner so as to become subject b the workers' o o penwilon taws of California, and agree that B I should become subject to the vmvA s' compensation provisions of Section 3700 of the labor Code. l shati forthwith comply with those provislom Data . 6 O Applicant_ WARNING: FAILVRE'TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN -ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 hereby shirr under penalty of perjury that them Is a construction lending agency for the performance of tf w work for whkh this permit Is Issued (Sas 3097. Civ. C.). Lender'.; Nana 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'applkation is made, each person at whose request and for whose benefit wok is performed under or pursuant to any permit Issued asa result of this application, the owner, and the applicant, each agmes b, and shall, defend, indemnify and hold harmless the City of Le Ouk►ta, its officers, agents and employees for any ad or omission related to fiavrork tieing perfomwd under ortonowing Issuance of this panni( 2 Any permit Issued as a result of this application becomes null and void fi OOrMhencod within 180 days from date of Issuance of such penNt or cessation of wok for 180 days will subjectpermit to dancetlation. 1 certify thhat t have read this apptkWon and state that the above Information Is I b comply with so city and county ordunanoes and state laws retailing to building construction, and hereby authorize representatives of this county er upon a tfoned property for inspection purposes. Signature (Appikant of Anent): Page 2 Application Number . . . . . 04-00006634 Date 10/05/04 Qty Unit Charge Per Extension 1.00 30:0000 EA ELEC PRIVATE SWIMMING POOL 30.00 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc Permit Fee . . . . 33.00 Plan Check Fee 8.25 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 ---------------------------------------------------------------------------- Permit . . . . . . WALL/FENCE PERMIT Additional desc Permit Fee 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 80 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments POOL & SPA. BBQ ANSI Z21-58-1995. 5 FL 4' BLOCK WALL CITY STND.'ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLA$TER INSPECTION. Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 306.00 .00 .00 306.00 Plan Check Total 148.35 .00 .00 148.35 Grand Total 454.35 .00 .00 454.35