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05-0241 (RPL).9F i 11 ot BUILDING & SAFETY DEPARTMENT Box 1.504 (760),777-701.2 )5 CALLE TAMPICO- FAX (760) 777-7011 UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT . umber X0_5=000-0_0_24 Date 1/25/05 Property Address . . . . . . 78485 VIA PALOMINO. APN: 604-032-999-117 -305212- Application description POOL RESIDENTIAL Property Zoning . . . LOW DENSITY RESIDENTIAL Application valuation 30000 Owner Contractor MARTINELLI AMERICAN POOL CONSTRUCTION INC 78485 VIA PALOMINO P.O. BOX 11996 LA QUINTA, CA PALM DESERT CA 92255 LA QUINTA CA 92253 WCC: STATE FUND WC: 238000.1188 09/22/05 CSLB: 518742 06/30/06 CCC: C53 Permit BLDG POOL PERMIT Additional desc . Permit Fee 284.50 Plan Check Fee 184.93 Issue Date . . Valuation 30000 Expiration Date_. 7/25/05 Qty *Unit Charge Per Extension BASE FEE '252.00 5.00 6.5000 THOU *BLDG 25,001-50,000 32.50 Permit . . . . . MECH POOL Additional desc Permit Fee 24.00 Plan Check Fee 6.00 Issue Date Valuation 0 Expiration Date 7/25/05 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 Check. Fee Issue Date Date .Valuation 0 Expiration Date 7/25/05 Qty Unit Charge Per Extension BASE FEE 15 00 1.00. 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 r 4 P.O. Box 1504'it9�ece '�C�� VOICE (760) 777-7012 78-495 CALLS O FAX (760) 777-7011 LA QUtNTA, CALIFORNIAFOR 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: O S-0Zy% I Date: �' i'7—ate Applicant Applicant's Mailing Address. 1 � 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 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Lis@nse is i _ II force and effect. j/ ,Lice icense Class �_� License No Date Contractor Y–,1 p r^ ' — C9', � C OWNER -BUILDER DECLARATION 1 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 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. , B.& 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 maintain work ' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ssue My w com n ation insurance came ppo4cay r are: CamA. Policy Num J c certify that, in the performance of the work for whi h 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 become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Vate "Applicant WARNING: FAILURE TO SECURE WORKERS' 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 perjuryt at 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 At � n Lender's Address I t 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 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 all city and county ordinances and state laws relating to building constructign, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Date I ik�� Signature (Applicant or Agent) 6� 1"L -A L Page 2 Application Number . . . 05-00000241 Date 1/25/05 Permit . . . . . . PLUMBING Additional-. desc Permit Fee . . 27.00 Plan Check Fee 6.75 Issue Date Valuation 0 Expiration•Date .7/25/05, .Qty Unit Charge 'Per Extension BASE FEE 15.00 1.O0 6.0000 EA." PLB FIXTURE 6.00 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 Special Notes and Comments POOL ONLY. ALARMS/BARRIER'S SHALL BE IN " PLACE PRIOR.TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged Paid Credited ----------------- Due Permit Fee Total 380.50 .00 .00 380.50 Plan. Check Total 208.93. .00 .00 208.93 Grand Total 589.43 .00 .`00 589.43