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04-5699 (RPL)BUILDING & SAFETY DEPARTMENT. P.O. Box i 504 (760).777 -7012 OF9`' 78-495 CALLS TAMPICO FAX (760) 7771-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIDN REQUESTS (760) 777-7153 BUILDING PERMIT Application Number04-00005699 Date 7/26/04 Property Address .-``79885 WILLIAM STONE WY APN: .604-491-009-9 -24197 - Application description . . . POOL -'RESIDENTIAL Property Zoning . . . . . . LOW DENSITY RESIDENTIAL -Application -valuation 21900, Owner 'Contractor ------------------ 7, ------------ PAUL TISZAL TISZAL MC CALLL34 POOLS _79-885 WILLIAM,STONE 46576 VIA CELESTE LA QUINTA CA 92253 INDIO CA 92201 (760) 775-5685 WCC: EXEMPT WC: EXEMPT 05/31/05 CSLB: 818835 04/30/05 CCC: C53 Permit . . . . . MECH POOL Additional desc Permit Fee. 2.4.00 Plan Check Fee 6.00 Issue Date . . . Valuation . . . . 0 Qty Unit Charge Per tension BASE FEE 15.00 1..00 9.0000 EA MECH FURNACE <=1 i0K Q Q 9.00 --------------------------------------------------,---------- Permit BLDG POOL -PERMIT. AUG - - - - Additional desc.. Permit Fee . . . . 225.00 PlanCheck�Fee•Itll�+�'�►',' 146.25 Issue Date . . . Valua ion Cl� err ro1rP� 21900. FI:oAMC -.- Qty Unit Charge Per Extension BASE FEE 45.00 20.00 9.0000 THOU BLDG 2,001-25,000 180.00 ------------------------------------------------------------------------- Permit . . . . . . ELEC POOL PERMIT -RES Additional desc Permit Fee . . . . 45.00 Plan C=zedk Fee 11.25 Issue Date . . ValuatLon 0 t Qty Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL— 30.00 P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: ©q- 5(a g ' I Date:—'7-30-04 Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDI G 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 Cede, and my Lic se is in ful f rce and effect. /License Class / license No../1 /� ///� ^ /� �8[E ? ✓(/! .nn}rarfnr Awl t—, • `I / 1/ _ l7 ABY _ OVVNER43UILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Cont ctors' 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 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 �'i of the work for which this permit is issued. —iihave 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 y wo ers' compensation i ce carrier and policy number are: amer olicy Number ertify 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 beco"�ubject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with tt(69EKovisions. , WARNING: FAILURE TO SECURk WORKER COMPENSATIONLOVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDR AND DOLLARS ($100,000), 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 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 Ouinta, its officers, agents and employees for any act or omission related to the work being performed 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 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 correct. I agree to comply with I city nd county ordinances and state laws relating to building construction, and hereby authorize representatives of is coun nter u t e above-mentiadr y or ins action purposes. to ignature (Applicant or Agent): • •.. ' tea, nd Page 2 Application Number 04-00005699 Date 7/26/04 Permit . . PLUMBING Additiona•l.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'OUTLE^S 3.00 Special Notes and Comments POOL & SPA. ALARMS AND BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUED IN PERMIT. Fee summary Charged Paid Credited Due Permit Fee•Total 327.00 .00 ..00 327.00 Plan Check Total 171.75 ..00 .00 171°.75 • Grand Total 498.75 .00 00 498.75 L Q 0 CITY OF LA Q IN TA BUILDING & SAFET DE T. FOR CONSTRU 1 ION `. DATE BY -] SPA 6PECIRCAT)ONS r on 7' son CUSTOM r XT8 S •, `Z Paul Tiszal Q 79-885 williamstone r7,laquinta 0 LIBERTY STREET APPROVED BY' 47 6 0) 273-6403 THIS DRAWING REMAINS THE PROPERTY Of MCCALLUM POOLS. REPRODUCTION OR UNAUTHORIZED USE INDIO, CA WITHOUT PERMISSION IS PROHIBITED. ' o Ln (U y F- - r J CITY OF LA Qin NT—A RE -INSPECTION FEE OF $30 BulLDlNG 8LJ,§ ►FETY�€�EPT-- N VVII I_ BE CHARGED IF THE APPROVED A �, OV~ .. IQQ (� R (1! FOR CON,STRUC; ION j GENERAL SPECIFICATIONS HE SITE FOR A SCHEDULED' I DATE- _av— 'tea i`SPECTION. + so NO EXCEPTIONS! � P= CAPA=ry T 8" ELM RAW 126I [� fig, a E� 14' 0' C i:. tD Kamm 3V � .. 0' LAD= NONE1 . N U U E t•=b' SPA SPECIRCATIONS 0a[ T ' *LAit CUSTOM i, W S ee�on moolm • � ''.I .. _ 7P9a-u�5a'lll ismston e laquinta N 0 LIBERTY STREET APPROVED BY . i 47001' 7ff-0,403 THIS DRANNOREMAINS THE PROPERTY OPMCCALLUM !� IN010,CA WITTHOOUTPEa I�HIISPPROR OHISITED.DRaEDusE 0 In I� . I t•=b' SPA SPECIRCATIONS 0a[ T ' *LAit CUSTOM i, W S ee�on moolm • � ''.I .. _ 7P9a-u�5a'lll ismston e laquinta N 0 LIBERTY STREET APPROVED BY . i 47001' 7ff-0,403 THIS DRANNOREMAINS THE PROPERTY OPMCCALLUM !� IN010,CA WITTHOOUTPEa I�HIISPPROR OHISITED.DRaEDusE 0 In I� . CITY OF LA QULNTA SUB-CONTRACTOR LIST JOB ADDRESS ori the job with the Building PERMIT NUMBER ,. OWNER BUILDER , Inspection Card at all times -in'a cons'aicuous place. ` Only • persons` appearing on this list or their employees are authorized to work +' : This form shall be posted Any changes to this list must be approved by the Building Division prior to commencement of work. Failure tb'comply will result in a stoppage of work and/or the voidance on this Job. applicable trade all information requested below must be completed by applicant. On File is not an acceptable response. ' each a I 4 of buildin 9 P rm t. For , x +. .. � .•• � ..Oti �- :............................. Stafc �C aro � ce S� .......... .......:::::::::::::::::.::.............. .::. nt ........::::.�:::.::::::::................. 'V11 �c sa lt�rt �, nc 1' �t5 #gyp 4C GJ•t ........::. 5.......x..5 1 kl au i . Company n Classification fcatio L'ce nse.Numb. er xxzxxX1 Date Ex p .D xXXX XX1e. Car rier Na me . State Fund, Polic • N umber Frmat Van'es1. Exp. Date xx/xx xx1 be_ r . License' Num- �1E xxxx xxxP/ x.xDaxtxe I, ... �� ,:. -. ;;;ox:->.:•:;.:::->::, :CE3Ntb��::f�:_BI:�:>::>::>:><:<.•>:>> .. . Lig N T _ C_ C. i_ C�J .G =0 - lD -�O 'i7 S �•} •C. '-3 • / lJ r - _ S � - ,. 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