04-7059 (RPL)n
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BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
OFTi9 78-495 CALLE TAMPICO FAX (760) 777 -7011 -
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number04-00007059 Date 11/04/04
Property Address 80726 VIA PESSARO
APN: 772-500-006- - -
Application description-. POOL' RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation 35000
Owner Contractor .
LONEGAN MICHAEL J AINSWORTH POOL CONSTR, ROBERT
PMB 220
�°"'--�.... 40 9 0 0 GLENMORE DRIVE
.50855 WASH NGTON ST `�-- 1 PALM DESERT CA 92211
LA QUINTA -CA.- 921253 (760) 568-4993
,,rte
I f WCC: AU INS SRVC
CJS~i WC: 00500018173 01/01/05
¢JPS9Cp�pq CSLB: 598681 07/31/06
CCC C53
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Permit BLDG POOL PERMIT
Additional desc
Permit Fee 317.00 Plan Check Fee 206.05
Issue -Date Valuation . . 35000
Qty Unit. Charge. Per Extension
BASE FEE 252.00
10.00 6.5000 THOU BLDG 25,001-50,000 65.00
Permit . . . . MECH POOL
Additional desc
Permit Fee 24.00 Pian 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 ELEC POOL .PERMIT=RES
Additional desc
Permit Fee 45.00 Plan Check Fee 11.25
Issue Date Valuation 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
Permit . . . . . . PLUMBING -
Additional desc
P.O. Box 15044h
4 "
78-495 CALLE TAMPICO Tf
LA QUINTA, CALIFORNIA 92253 4
BUILDING & SAFETY DEPARTMENT
Application Number: _ E>�- 70'S 9
Applicant:
Applicant's Malting Address:
Architect or Engineer:
-a '\y
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1 /-12 -o
Architect or Engineer's Address:
Lic. No..
bUILUING 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 Li�egs� is in full force and effect.
License Cl nns-•L-.h 1 License No.
gD- J D
ate I L Contractor ^ IVSW W ` �I Pec s
OWNER -BUILDER DECLARATION
I 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).):
(--) 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.).
(-,) 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 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, 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 permit is
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M pyo ers',Go pensation insurance erjer,�gd�oli nur qe�a�;
6Carrie�- �4 � of �s � i/�U1't Y� Policy Number •� �5��u1
_ I certify that, in the performance of the work for which this permit rs sued, 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
rIDa a forthwith comply with those provisions. t 1 !`, plicaPOOLnt~ bl (�7
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 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, indemnify 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 ' rmalion is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction land hereby authorize representatives of this count to ter upon the above-mentioned property for inspection purposes.
Date--1j�_ ` 6 Signature (Applicant or Agent): _lrl—,'
Page 2
Application Number 04'-00007059
Date 11/04/0.4
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 .00.00 .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, FOUNTAIN. ALARMS/BARRIERS
SHALL BE IN PLACE AT PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE. NOT.
INCLUDED ;
Fee summary Charged Paid=Credited
Due
Permit Fee Total -419.00 00 .00
419•.00
Plan Check Total 231.55,, 00 .00'
231.55
Grand Total.' 650,55 00; .00
,650.55
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