04-6392 (RPL)o Aq
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u ZQO BUILDING & SAFETY -DEPARTMENT
P.Ga--BQox-L594 (760) 777-70.12
c�oFT9
78-49-11tiivnMPaco FAX (760)'77.7=7011
LA QUINTA, CALIFORNIA .92253 INSPECTION REQUESTS (760) 777-7153
BUILDING: PERMIT ;
Application Number 04-00006392 Date 9/22/04'
Property Address;-• 78510 VIA PALOMINO.
APN: 604-032-999-98 -30'5212-
. Application description' POOL' -.RESIDENTIAL
Property.Zoning LOW-DENSITY RESIDENTIAL
..Application valuation 17000 -
Owner.,. Contractor
LENNAR HOMES' OF CALIFORNIA CALIFORNIA POOLS & SPAS
78401 HIGHWAY 111,- S'A'E C. P.O. BOX 1280
LA .QUINTA,.. CA COACHELLA ... CA 92236
LA- QUI'NTA . CA 92253:'. .(760•) 39'8=922.2-'
WCC:. ..STATE FUND...
WC.;'.'.-. 04.600.0.61168 01/O1/05;,If
C'SLB: 656128 ". 10/31/04,',"
CCC: C.8 -C27 -C29-053 k
--------------------------------_- --- ----------------------=--- ---- ----=-=------',w',
Permit MECH POOL'
Additional desc
Permit.. Fee 24.00 Plan Check Fee 6.0.0 �?
Issue .Date Valuation 0
Qty ,Unit Charge . •Pe.r Extension
BASE- FEE... 15.00
1.0.0
.9.00.00 .EA- MECH FURNACE <=10 0 K 9.00
Permit BLDG POOL PERMIT
Additional.desc
Permit .Fee 180..00 Plan Check Fee " . 117.00
Issue.Date Valuatpn:.. 17000.
Qty Unit Charge Per Extension
BASE FEE 45.:00
15:00 .9.0000 THOU BLDG 2,001-25,000 135.00
---------------------------
Permit ELEC POOL PERMIT=RES.
Additional desc .
Permit Fee. 45.00 Plan Check.F' 11:25
Issue Date.. Valuation 0
-'Qty :,Unit Charge Per : 'Extension
BASE •FEE• 15..00
P.O. BOX 1504 T&f
78-495 CALLE TAMPiCO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number.
Applicant:
Appucant-s Mailing Address:
Architect or Engineer
VOICE (766) 777-7012
: FAX (760) 777-7011
INSPECTION$. (760) 777.7153 -
Date: .
77-7153
Date:. q.,2
Architect or Engineer's d S:
Uc. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under
penalty of perjury that I am licensed under provisions of Chapter 9 (commenckp with Sedicn 7000) of Division 3 of the Business and Professionals
CodeLicense �y L - Lis S3 force and effect. License No. 10.61 a s
Data 71 49 G Contactor `
OWNER43UILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contradors' State License Lew for the following reason (See. 7031.!5. Bushes 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 mom the applicant for the. permit to file a signed
statement that he or the Is lioensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of dro Business
and Professions t) 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 pemdt subjects
the applicant to a cM penalty of not more than five hundred dollars ($500).) .
(� I. as owner of the property, or my employees with wages as their $ole compensation. will do the work and the structure Is not Intended or offered for sale (Sea 7044.
Business and Professions Code: The Contractors' State License Law does not appy to an owner of property who builds or improve; thereon, and who does the woik
himself or herself or through his or her own employees. provided that the improvements are not intended or offered for safe. H, however, the building or kMmvefrobnt is
sold within one year of completion, the owrw ul der will have the burden of proving that he or she did not bugd or knprove for the purpose of sate.)
(, 1. as owner of the properly, am exdusivey contracting with licensed contradas to construct the project (Sea 7044. Business and Professions Code: The Contractors' .
State License Law does not appy to an owner of property who builds or Improves themon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U 1 am exempt under See. _ B.& PSC. for this reason _.. .
Date Owner-_
WORKERS' COMPENSATION DECLARATION.
hereby affirm under penalty of perjury qne of the fofiowinq dedaretiogs:.
_ . have and.wlll maintain a cortlficate of consent to seifansure for workers' compensation, as provided for by Section 3700 of the Labor Code, forft performance
of the work for which this pend! is issued. .
I have end will maintain workers' compensation insurance. es required Dy'Sedbn 3700 of the Labor Code, for the performance of the work for which this pemmit is
lysin My wo rs' con ensatlon.iimsurence carrier and pr�ymber aro:
Cartier' _;. P • - , Policy Number O �,/(o�/Y� l ///e
I.oertry that in the perfom>a for is the work for which this penitis issued, I ahati not employ any person in any manner so as to become subject to the workers'
compensation laws of Cafifonda, and agree that H I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
nforthwith comply with those ns.
Date [ G 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 D6L1ARS ($100,o00). IN.ADDmON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
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 (Sea 3097. Civ. C.).
Lenders Name.
Lender's Address
IMPORTANT Y APPLICANT ACKNOWLEDGEMENT
Appticatlon 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 resuR of this application, the owner, and the applicard. each s fo;t �nd shall, defend. Indemnify and hold harmless the City of La Quints, its
officers, agents and employees for any act or omission related4vold
'ng ptirfommed under or fotlowing issuance of this pent
2 Any permit Issued as a result of this application becomes null fa not commenced wlthin.180 days from date of issuance of such pemrit, or
cessation of work for 180 days will subject pemdt to cancellati
certify that I have read this application and state that the above informatiagree to cortply with all city and county ordinanoea and state laws relating to building
construction, and hereby authorize representatives of this county to nter tionad property for Inspection purposes
Date �� Signature (Applicant or Agent): d
..-
`i
1
Page 2
Application Number 04-,00006392.
Date 9/22/04
Qty Unit Charge Per
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
3.0000 EA PLB WATER INST/ALT/.REP
3.00
1.'00 = 3.0000 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.
240
,Qty Uni.t Charge Per
Extension
BASE FEE
.15.00
Special Notes and Comments.
POOL & SPA. FIREPIT 496 AGAL. 15'LF 4'
BLOCK WALL.CITY STND.�-ALARMS BARRIERS
SHALL'BE IN'PLACE PRIOR TO`PREPLASTER
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