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04-3819 (RPL)T44f 4.4 aaha P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number . . Property Address . . . APN: Application description Property Zoning . . Application valuation BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 . 04-00003819 . . . 53519 VIA PALACIO 772-560-044- . . . POOL - RESIDENTIA . . . LOW DENSITY RESID . . . 40000 Date 4/30/04 JTIAL.. ,� +!+ N 5 2 04 �.., Owner Contractor'-=""��"�"'1'' t ------------------------ ---=-------------------- HAYNES JOHN/DONNA AINSWORTH POOL CONSTR, ROBERT 53519 VIA PALACIO 40900 GLENMORE DRIVE LA QUINTA CA 92253 PALM DESERT CA 92211 (760) 568-4993 WCC: AU INS SRVC WC: 00500018173 01/01/05 CSLB: 598681 07/31/04 CCC: C53 ---------------------------------------------------------------------------- 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 . . . . . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 349.50 Plan Check Fee 227.18 Issue Date . . . . Valuation . . . . 40000 Qty Unit Charge Per Extension BASE FEE 252.00 15.00 6.5,0,0:0 THOU BLDG 25,001-50,000 97.50 ---------------------------------------------------------------------------- Permit . . . . ELEC POOL PERMIT -RES Additional desc Permit Fee 45.00 Plan .Check Fee 11.25 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per 1.00 .30.0000 EA Extension BASE FEE 15.00 ELEC PRIVATE SWIMMING POOL 30.00 P.O. BOX 1504• " VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUtNrp, CALIFORNIA 92253 4 4 a INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: oy— 3YI 6 1 Date: Applicant: Applicant's Mailing Address: d*dM4z-., Architect or Engineer: Architect or Engineer's r Lic. No.: a 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 Lic Ps is in full force and effect. �� C -( b y [License Class/ Lice se No. J Q 1 Y -Date o V ?f Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I a xempt 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 t4 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 s4e 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, asoprovided 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 issued. My workers' compensation insurance carrier and policy number are: Cartier Policy Number I certify that, in the performance work r 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 Calif. d a e that, if 1 should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall fortwith comply with those ovisi ns. Date Lf Applicant WARNING: FAILURE TO SECURE WORKER4 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. 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, 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 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 all city and county ordinances and state laws relating to building construction, and ere'byf authorize representatives of this cou o enter upon the above-mentioned property for inspection purposes. Date �� y Signature (Applicant or Agent): Page 2 Application Number . . . . . 04-00003819 = Date 4/30/04 ------------------_------------------ Permit . . . . . -PLUMBING ---------------------- ----------------- Additional de.sc . - 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 . 000.0.. EA :. PLB FIXTURE 12.00 1:00 3''.000& EA PLB WATER INST/ALT/.REP 3.00 Y..00 , .. 3:,`- 000.0, EA PLB GAS PIPE • 174 OUTLETS 3�. 00 ----------------------------------------- Special.Notes and Comments.. --------------------------..--------- POOL & SPA. ALARMS BARRIERS`'SHALL BE IN PLACE PRIOR. TO-, PREPLASTER INSPECTION, Fee summary Charged -- - - - - - - - - - - - - - ------ - - Paid Credited Due - - -- _-- Permit Fee Total 451•.50 -- - - - - ------ - - - - -- .00 .00 ---- - - - - -- 451.50 Plan Check Total -252.-6d .'00 . 00 ' 252.68 Grand Total 704-.18 - .00 .00 .704:18 A4.1 7" u —t66� '1 R 1:3'— 5MGH WALL pO '22'E N82 501-j�- O F ------ ----------- Dafl L-1 FOt NTAIN t---�------- - -- RE-INSP CT 0 B 'CHA99 IFIL A VED-- r" A Al. 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