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04-4500 (RPL)I I k� _. . I agwo BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAM PICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 922.53 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number 04-00004.500 Date Property Address .5/21/04 80299 VIA PESSARO. APN: 772-550-054- .1�pplication description . . . POOL - RESIDE14TIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuF�tion 60000 Owner Contractor --------- ------------------------ GORDON ROSS -------------- AINSWORTH POOL CONSTR, ROBERT 80299 VIA PE:�'SARO' 409.00 GLENMORE DRIVE LA QUINTA CA 92253 PALM DESERT. CA 92211 (760) 568 -499 - WCC: AU INS :SRVC WC: 00500018173 01/01/05 CSLB: 5986E1 07/31/04' CCC: C53 --------------------------------------------------------- 7 --------------------- Pe-rA"2.'r_ MECH POOL A0!3-11 t i ona 1 desc ' c�rmit'Fee. 24.00 P1 an Check Fee 6.00 Tssi-le Date Valuation . . . . 0 �,-ty.- Unit Charge Per Extension BASE FEE 15.00 9.0000 EA - - - - - - - - - - - - - - - - - - - --7 - MECH FURNACE <=100K 9.00. 7 - - - - - - - - -7 Permi� . . . . ... . BLDG -POOL 7 - - - - - - - --- - - - - - - - - - 7 - - - - - - - - - - - - - - - - - - - - - - - - - PERMIT Additional desc'. Permi-.-- Fee �459.50 Plan Check Fee 298.6*8 Issue.Date . . . . Valuation. .60000. Qi -.y -Unit Charge Per. Extension BASE FEE 414.50 10.00 4.5000 THOU BLDG 50,001-100,000 45.00 -------------- ---------------- Permit ELEC --------------------------------- POOL.PERMIT-RES. Additionaldesc PermIt Fee . . . . .45.00 Plan Ch-e--c-k F,"'ei"--' 1. 2 5 Issue Date . . . . Valuat�'I' ion, 0 (�-ty Unit.Charge Per xt, e� -Sion BASE FEE 15.00 'POcD'L' 1.00 30.0000 EA ELEC PRIVATE SWIMMIN\ 30. . 00 P.O. BOX 1504 78-495 CALLE TAMP*ico VOICE (760) 777-7012 LA QUINTA, CALIFORNIA §2253 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT APPI ication Number: 4!Q � - I Date: . I Applicant: Applicant's Ma iling Address: Architect or Engineer Architect or .Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1. am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my LlcensaNin full force and effect. License Class__I,�.�.. License No. Data contractor /b'5VIPLTH Poo I (�A/gk- P_ A( 17,jrj OWNIER­BUILDEk DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 703i.S. 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 d* permit to file a signed statement that tie 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 Pmfessions-Code�orthat-he-or-she-is-exempt4herefrom-and-the-basit-for Ov-slieged-exemoon.--Any-ftlatio-n--al-SdMo—n 7011-.5-6y —anyappliain—t f6ir —apermit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 1. 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 Conti -actors' State License Law does not apply tD 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 orimprovement 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.). L) 1. as owner of -the property. am exclusively contracting with licensed contractors to c6nistruct.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 WQRKERS'COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have. and will maintain a certificate of consent to self4nsure for workers' compensation, as proyided'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 I . his permit is d My w corn?Ti ton insurance ca ier ar li,� re: go aumbe Carrier �6. U Z, Policy Numberm ) 4 1 131:11 - , —I certify that in the performanc of the work for which this permit is issued, I itiall -got employ any person In'any manner so as to become subject to the workers' compensation la 'Ca d that, if -should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith can ply �n agree Z, -Date Applican WARNING: FAILURE TO SECURE �VORK�kS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT . AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOLMAND 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 u�der penalty of perjury that there is a construction lending agency for tha performance of the work for which this permit Is Issued (See. 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 Quints, 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 penT4 or cessation of work for 180 days will subject permit to cancellation.' I ce* 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 cc ?tyente Lupon' thea abo ntioned property for inspection purposes. Date— Signa lure (Applicantor Agent): Page 2 Application Number . . . . . 04-000b4500 Date 5/21/04 -------------------------- 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 2.00 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 1-4 OUTLETS 3.00 Special Notes*and 7 -------------------------------------------------------- Comments POOL &,SPA. FOUNTAIN. ALARMS BARRIERS SHALL -BE IN PLACE PRIOR TO'PREPLASTER INSPECTION. Fee.summary ----------------- Charged Paid Credited Due Permit Fee ---------- ---------- ---------- Total 561.50 .00 OD ---------- 561.50 Plan Check Total 324.18 .00 OD 324.18 Grand Total 885,.6& .00 OD 885.68 I kimill JFV V`7/ Oro FA U!'WIAVA , INAFAVA ml� a r W!,4 Moo rl FAPO� K m 9 ;;l;: DINE DENCE: a9mmumot, SZ;