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05-1882 (RPL)P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 5/17/,05 Application Number: 0.5-00001882 Owner: Property Address: 80280 VIA PESSARO ROSS GORDON APN: 772-550-012- - - 42-829 COOK STREET Application description: POOL - Si IAL SUITE 104 Pr2porty 7nninr3• T NSZT IDENTIAL PALM DESERT, CA 92211 Application valuati 0 �QJ Contractor: Applicant: O Mai 1 Arc itect or Engineer: AINSWORTH POOL CONSTR, ROBERT F�®U\P. WCC: VIRGINIA SURETY WC: 005-0024833 01/01/06 ✓, /i G\�Of CSLB: 598681 07/31/06 - --------=---------------------------------------- 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 ofessionals Code, anLicen�e is in_. fu fl�foice and effect. Li ense Clja�s : ` LircEeNo.i�K e1Q.1Dater 1-) OS Contracto OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's State License Law (Chapter 9 (commencing with Section 70001 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).: (_) 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 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.). (_ 1 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.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: 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: LQPERMIT ----------------------------------------------— WORKER'S 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 workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this ermit is issued. My workers' compensation / inyr�s cp�carr�r jnd policy number are: C rier C53 5_l.J(o0 Policy Number' - - - - - - - - - - - - - -- _ I certify that, in the performance of the work for 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 California, and agree that, if I should become t to the workers' compensation provisions of Section ►/t� 3700 of the Labor C all f w rthwit comply those provisions. Dawe1 t 1 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. ' 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, indemnify 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(inf ion is correct. I agree to comply with all city an •county ordinances and state laws relating to building cotion, and hereby uthorize representatives oft coyo center upon the above-mentioned pr n p poses. /ate:fJ 1� v Signature (Applicant or Agent): Application Number . . . . . 05-00001882 Permit . . . BLDG POOL PERMIT Additional desc . Permit Fee . . . . 349.50 Plan Check Fee 227.18 Issue.Date . . . . Valuation . . . . 40000 Expiration Date 11/13/05 Qty Unit Charge Per Extension BASE FEE 252.00 15.00 ----------------------------------------------------- 6.5000 THOU BLDG 25,001-50,000 97.50 ------- Permit . . . MECH POOL. Additional desc . . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/13/05 Qty Unit Charge Per Extension . BASE FEE 15.00 1.00 ---------------------------------------------------------------------------- 11.0000 EA MECH FURNACE >100K 11.00 Permit . . . ELEC POOL PERMIT -RES Additional desc . . Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date Valuation . . . . 0 Expiration Date 11/13/05 Qty Unit Charge Per Extension BASE FEE 15.00 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 Expiration Date 11/13/05 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 Comments POOL & SPA ONLY. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT LQPERMIT Application Number . . . . . 05-00001882 --------------------------------------------------=------------------------- Special Notes and Comments INCLUDED IN PERMIT. Fee summary ----------------- Charged ---------- Paid Credited ------------------------------ Due Permit Fee Total 453.50 .00 .00 453.50 Plan Check Total 253.18 .00 .00 253.18 Grand Total 706.68 .00 .00 706.68 LQPERMIT a "++�RfA■r/..�.�RrR�;�iiii�i�r�i"iii i�iii�i�i�ii� $OMEN '"Nomm ANN iieai�iiii;; ..�1 Ir. ��' , ter► �i. �c�,