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04-4561 (RPL)° uiw. BUILDING & SAFETY DEPARTMENT c �4 P.0 -BOX 1504 (760).777-7.012 OF 9 78-495 CALLE TAMPico. FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSP.CTION REQUESTS (760) 777,-7.153 BUILDING PERMIT Application Number 04-0_-00,04.5.6.1 Date ' 5/25/04 Property Address ... . . 552'07 WINGED,FOOT APN:775=330-004 -.29121 Application description- a POOL RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL, :Application valuation 25000 Owner.Contractor DAN CAMPBELL PARZINSKY"POOL, INC., RICH 55207 WINGED FOOT P.O..BOX 897 LA'QUINTA CA -92253• "PALM SPRINGS CA 92263 (760) .324-5827 �. WCC: 'STATE FUND WC: 1739513 08/15/04 CSLB: 431055 .1. 10/31/04 CCC:. C8:-053 Permit . . . . . . BLDG POOL PERMIT Additional desc Permit Fee. 252.00 Plar- Check Fee 163.-80, Issue Date 'Valu-ation . 25000 Qty.,; Unit'Charge Per Extension BASE FEE h 45.00 23.00 9.0000 THOU BLDG 2.,.0.01-25,000 207..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 -Ch' k Fee 11.25 Issue Date Valuati.n 0 Qty Unit Charge Per 1 si.on BASE FEE [1;4A2 5.00 1' .00 30.0000 EA ELEC PRIVATE SWIMM,N� POO , 7�po4 3"0.00 C� ��F E 0OI��� P.O. Box 1504 78-495 CALLE TAMPICO VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 Todf Ot FAX (760) 777-701 1 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: (v4 • 45(p I Date: Applicant: I I Architect or Engineer: Applicant's Mailing Address: hrcnitect or tnglneer's Address: A)IA 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 Li��rtse . iryfull force and effect. License Class Cl� J �se No. I C) S1/ Date f/� -,OT ont uor 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).): 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 ft 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 contractors) 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 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 iss%C STS ed. Y.�^rsb ompens --Policy Number carrier and pglc number are: Amer li'f-6T policy Number _ J y I-� z _ I certify that, in the performance of the work for which this perrrnt 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, I shall forthwith comply with those provisions. ,.- S-2 7 - WARNING: FAILURE TO SECURE WORK9'RS' COMPENSATION 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. I herebyaffirm under CONSTRUCTION LENDING AGENCY 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 IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT Safety ACKNOWLEDGEMENT NT APermit to the 1. Each person upon whose behalf this application is made, each person at whose request and for hoose benefit work snperformed under or puset forth on this appI cationsuant to any permit 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 Quinta, 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 dayt 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 all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to ent r the above-mentioned property for inspection purposes. �0ate ignature (Applicant or Agent): Page 2 Application Number 04-00,004561 Date 5/25/04 ------------------------------------------------------------------------------ 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 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-� OUTLETS 3.00 Special Notes and Comments POOL/SPA. ALARMS/BARRIERS SHALL BE IN 41 PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee,summary Charged Paid -.Credited. Due Permit Fee Total 354.00 .00 .00 354.00 Plan Check Total 189.30 .00 .00 189.30 Grand Total 543.30 .00 .00 543,.30 Please be Teabded Ittat.:ottce & horneown r ctii 0iq�t6ucrda surfaces. C•ASeoaiation bas uo tts;tonsibllttp :ityr• •ttutinteneir or tepait� ::fOr suc>ti ' ±►�iitsf Per iter . Aral Cnidcunc.s. t+ePcrence page 7:.:Sectioii•-b — Patio Dug 8t Pada'.• :: , �y nye to Uec afotrmcctrioned ste�fl be at the ilwtt�'s-ei tt ' . , ... ` dosii or cba sc. . ire titlbee reaommareds• :tbgr: you review tits ottctesed syecificstions for ttte POA west: cdncretc i*Lv. f& 6rtsidwMion pMo decking prfor is the tostellation of your Please rater to : page 7 of 20 of th*e..: ti*tehitcdtrr� :: } :.: b�E h Ehattgc, whlcit states...."Landsca/lrcf blMn�dt�fn APP catty for~ $. �fglil!!ig r�.:ti t: Q►d/re►+e to aha: MrlO'w theme unless otherwise approved and any do vsp ur cl+carga to the Ajhv nreartio�rad�►ioN ba ar ►her fl�orret"s rsprnse• Please contact• MAT%* Alvarez,• supcsvi�tr.foi :Stenshittd.. • .' 76ti/346.39�9 8�td Caro Futter, ft Assncisfion Maft� er prior to a itri 8 oY iaodifridons'oicd w >dlga.::lrr�age to the �P�• . , sfet'eib6..trttes. i�otvcrs stat:.. is the must be brought bat4c to tt8 od � ` of the c°�tpr:.:.:�0 landscaping with the w*rsadg tathem will bc. no:At:c�fittttoCntlattto pr :ts eofttpleted mitis applic tirnt is 3pDroved Upon oomplotitin ori your:pmfea; ptcase:eiirnp)etc aiYd .itiSt> ii: 3ie Notioc of CatnpleO iiN-bf Architwtwaf Change• . �' .' , � I ��' . -_ . 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