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04-5632 (RPL)f u�ttcv BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 0F.,9 78-495 CALLS TAMP,ICO FAX (760) 777-7011 y LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 04 �ob00563_ Date. 7/22/04 Property Address 55011 WINGED FOOT APN: 775-330-011- Application description POOL - RESIDENTI -Property Zoning LOW DENSITY RESI. Application, valuation 17000 Owner Contractor JUL 2004 ------=----------------- r FIRST PACIFICA CALIFORNIA 00 = ON^ 5 E. CITRUS'STE. 205 P.O: BOX 12.80 REDLANDS, COACHELLA CA 92236 REDLANDS, CA 92373 (760) 398-9222 WCC: STATE FUND WC: 04600061168 01/01/05 CSLB: 656128 10/31/04 CCC: C8 -C27 -C29-053 Permit . . . . BLDG POOL PERMIT Additional.desc Permit Fee- 180.00 Plan C:zeck Fee 117.00 Issue Date . . Valuation 16610. Qty Unit .Charge Per Extension BASE .FEE.. L 45.00- -15.00 9.0000 THOU .BLDG 2.;`001-25,,000• 135.00 Permit . . . MECH POOL Additional desc Permit Fee 24.00 Plan Ch"eck Fee 6.00 Issue:Date Valuat=on 0 Qty Unit Charge' Per Extension BASE FEE 15.00 1.00 9.0'000 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 P.O. BOX 1504 78-495 CALLE TAMPICO �r LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number:y y- -Z2 (o fid., Applicant: Applicant's Mailing Address: Architect or Engineer: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760),,777-7153 Date: Architect or Engineer's Address: 01/4 Lic. No.: tsUILUINU PERMIT DECLARATIONS Ll D CONTRACTOR'S DECLARATION I hereby.affirm under penalty of perjury that I am licensed under visio s of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals and my Licy9se i f I force and effect. / cam- j / License Class I /} Licfns No. e" J (cam / /OWNER -BUILDER DECLARATION affirm I. hereby arm under penalty of perjury that I am exempt from 42ritractors' 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 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 have and will maintainorkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is 5. / iss� S.& M}y workers' ompensatio rance carrieCJd W,6 barn% Carrier fa { f�•� PolicyNumber (J _ I certify that, in the performance of the work for whic thi tis 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, I ould come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those prov' ions. ,---Date ZtpL" PPlirnnt WARNING: FAILURE TO SECURE WORK RS' COM SAT COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND 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.). 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 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 wo being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if ork is menced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. 1 certify that 1 have read this application and state that the above i rmation is I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this coun enter upon a ov / ritoned property for inspection purposes. Date �0616Si/gnatujre (Applicant or Agent): Page 2 Application Number '04-00005632 Date 7/22/04 Qty Unit Charge Perc 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 3.000.0 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 390 Qty Unit Charge Per Extension BASE FEE 15.00 . ---------------------------------------------------------------------------- Special Notes and Comments POOL/SPA, 18 L.F. 5' GARDEN WALL, CITY STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE AT -PRE -PLASTER INSPECTION Fee summary Charged Paid Credited Due " Permit Fee Total 297.00 .00 .00` 297.00 Plan Check Total 142.50 .00 .00 142.50 Grand Total 439.50 .00 .00 439.50