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04-4823 (RPL)_: Taf 4 4 C1" 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 Application Number Property Address . . . APN: Application description Property Zoning . . . . Application valuation Owner TOLL CA V .0/O KEVIN D DUERMIT 8901 E MOUNTAIN VIEW 200 SCOTTSDALE r---A-Z- ----------------------- t Permit . . . . . . Additional desc Permit Fee Issue Date . . . . BUILDING PERMIT `v04-00004823`— Date 6/08/04 . . . 51641 EL DORADO DR .772-250-996-171 -31349 - . . . POOL - RESIDENTIAL . . . LOW DENSITY RESIDENTIAL . . . .17000 Contractor CALIFORNIA POOLS & SPAS P.O. BOX 1280 COACHELLA CA 92236 (76,0) 398-9222 CITY OF I.A QS1;C3 a 180.00 Plan Check Fee 117.00 Valuation . . . 16936 .Qty Unit Charge Per. Extension BASE -FEE 45.00 15.00 9.0000 THOU BLDG 2,001-25,000 135.00 =---------------------------------------------------- =---------------------- 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 . . . . . . 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 WCC: STATE FUND y W C. 04600061168 01/01/05 JUN 161C04 !� CSLB: 656128 10/31/04 Lj CCC: C8 -C27 -C29-053 CITY OF I.A QS1;C3 a 180.00 Plan Check Fee 117.00 Valuation . . . 16936 .Qty Unit Charge Per. Extension BASE -FEE 45.00 15.00 9.0000 THOU BLDG 2,001-25,000 135.00 =---------------------------------------------------- =---------------------- 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 . . . . . . 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 f P.O. Box 1504_ - VOICE (760) 777-701_ 78-495 CALLE TAMPICO FAX (760) 777-701 c&f 4 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777.715_ BUILDING & SAFETY DEPARTMENT Application Number: !G ` Sa 3 I Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: a 1A 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 k ,in II'torce and effect. �/� /License Class 43 License Now 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 (5500).): U I, as own& of the property. or my employees with wages as their sole compensation. will do the worts, 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 1, 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. . B.6 P.C. for this reason Date - Owner WORKERS' COMPENSATION DECLARATION 1 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 ue orkels compensation ce carer and pol11�v�ypbar are: / artier �.��4 P umber v 7(v �� 6116 46 _ I certify that, in the performance of the work for which this permit 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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shell forthwith comply with those provisionA. /y ,--- Date G 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 (5100.000), 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.). 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 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 per %il issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend. indemnity and hold harmless the City of La CtdMa, its officers, agents and employees for any act or omission related to the work being perforned 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 penrK or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this applicatiori and state that the above info tion is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county t e ar upo the above rrtentioned property for inspection purposes. ate yLCaSignature (Applicant or Agent): Application Number . . . . . 04-00004823 Page 2 Date 6/08/04 Qty Unit Charge Per I 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 . . . . 64 Qty Unit Charge Per _ Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments POOL/SPA, BBQ(ANSI Z21-58-1995), 4 L.F. 41BLOCK WALL, CITY STANDARD ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. Fee summary Charged ------------ - ---- ---------- Permit Fee Total 297.00 Plan Check Total 142.50 Grand Total 439.50 Paid Credited Due ---------- ---- - ----- ---------- .00 .00 297.00 .00 .00 142.50 .00 .00 439.50