04-7199 (SOTB)r `,
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760),777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number
04--00.0.07199 Date
11/15/04 "
Property Address . . . .
. . 51585 EL DORADO DR
APN:
772-250-996-173 -31349 -
Application description .
. . STRUCTURES OTHER THAN BUILDINGS
Property Zoning
LOW DENSITY RESIDENTIAL
Application valuation . .
. . 2500
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
1!
WC: 04600061168
01/01/05
j-'
CSLB: 65.6128
10/31/06
!;
CCC: C8 -C27 -C29-053
Permit . . . . BU'iLDING
PERMIT
Additional desc .
Permit Fee . . . . .54:00
Plan Check Fee
35.10
Issue Date
Valuation . . . .
2500
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU
BLDG 2,001-25,000
9.00
-----------------------------------------------------
Permit . . . . . . PLUMBING
------------------------
Additional desc
Permit Fee . . . .
18.00 Plan Check Fee
4.50
Issue Date
Valuation . . . .
0
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA
PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
KIVA - OUTDOOR FIREPLACE PER APPROVED
PLANS
----------------------------------------------------------------------------
Other Fees . . . . . . .
. . ENERGY REVIEW FEE
3.51
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 72.00 .00 .00 72.00
Plan Check Total 39.60 .00 .00 39.60
P.O. Box 1504�� VOICE (760) 777-7012
Tlihf
78-495 CALLE TAMPICO FAX'(760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
. BUILDING & SAFETY DEPARTMENT
Application Number: 0a - I l Q qDate: u 15-04P
I
Applicant: Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
SED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed u der rovisi sof Chapter 9_(cammencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Lice a is i force and effect. f�Ld(�
cense Class se No.
)6517W
/ N--,' 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).):
V 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 qave agd will maintain ers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issu orkers' pensation i rance carne cy`number C
iGamer -Policy Number C/lee
_ certify that, in the performance of the work for which is pe it is issued, 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 should b come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
/ forthwith comply with those provi ' S.
/date G //ZZ15-4e plicant
WARNING: FAILURE TO SECURE WORK RS' COCPENAT4i VERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND D 000), IN 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 A
/�
Lenders 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 erformed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if � ork is no mmenced 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 co ct. I agree comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to ter upon th ove-me coned property for inspection purposes.
ate / Si� (Applicant or Agent):
-i
Page 2
Application Number . . . . . 04-00007199 Date 11/15/04
Other Fee Total 4.01 .00 .00 4.01
Grand Total 115.61 .00 .00 115.61