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04-5414 (RPL)04, 7e8-495 CALLE AMPICO A, C LIFORNIA 92253 BUILDING PERMIT Application Number Property Address APN: Application description Property Zoning -Application valuation Owner ---------------------- 7 - TOLL CA V C/O KEVIN D DUERMIT 8901 E MOUNTAIN VIEW 200 - SCOTTSDALE AZ 85258 BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 04-00005414 Date 7/12/04 51893 EL DORADO DR 772-250-996-162 -31349 POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 18000 Contractor ------------------------ CALIFORNIA -------------------7CALIFORNIA POOLS & SPAS P.O. BOX 1280 COACHELLA .CA 92236 (760) 398-9222 Qty Unit Charge Per Extension BASE FEE 15.00 WCC: STATE FUND WC: 04600061168 01/01/05 CSLB: 656128 10/31/04 CCC: C8-C27.-C29LC53 ----------------------------------------------------------------------------- Permit BLDG POOL PERMIT Additional desc Permit Fee 189.00 Plan Check Fee 122.85 Is'sue Date Valuation 17892 Qty Unit Charge Per Extension BASE FEE 45.00 16.00 9.0000 THOU BLDG 2,001-25,000 144.00 -------------------------------------------------------------------- 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 ... . . - - - - - - - - - - - - - - - - - - - 7 - - - - - - - - - --- - - - - - - - - - - - - - - - - . . ELEC POOL PERMIT -RES - - - - - - - - - - Additionaldesc Permit Fee 45.00 Plan Check Fee 11.25 .Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 P.O. Box.1504 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4 4 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: 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 (commen 'ng with Section 7000) of Division 3 of the Business and Professionals C e, and my Licen�g is irk X11 rce. and effect. S.— nse Clais ( _--5 n Licens/Fl 7 ,O W� ER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the tractors' 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 m Owner. WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 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 INpermit is issued. _ I have and will maintain rkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is iss d. orke s' , mpensation insurance carrier an,d�pplic number re: Cartier Policy Number Q `'L LV �d� I certify that, in the perforrhance of. the work for which is r itis 'ssued, 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 sh !d be a subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall —�fLort�hwith comply with those 7prions. ,-15ate plignt WARNING: FAILURE TO SECURE WOf KERS' COMPkOA N 9OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ,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 1 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 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, an , efend, indemnify and hold harmless the City of La Ouinta, its officers, agents and employees for any actor omission related to the work being rf rtned under or following issuance of this permit. 2. Airy permit issued as a result of this application becomes null and void if work i not mmen 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 in"ation is con I gree to com with all city and county ordinances and state laws relating to building construction, andel hereby authorize representatives of this county 6 titer upon bov -men 'on roperty for inspection purposes. gate `CC ignature (Applicant or Agent): rs Application Number . 04-00005414 Page .2 Date 7/12/04 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 . . . . 108 .Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------- Special Notes and Comments ----------------- POOL/SPA. BBQ(ANSI Z21-58-1995), 5 L.F. 5- BLOCK WALL, CITY STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER 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