04-5371 (RPL)w
P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUI-DING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . 04-00_0.0.5371 Date 7/07/04
Property Address . . . . . 53460 AVENIDA V=LA
APN: 774-094-012-13 -000000-
Application description . . . POOL - RESIDENTIAL
Property Zoning . . . . . . . COVE RESIDENTIAL
Application valuation . . . . 15000
Owner Contractcr
---=-------------------- -----------------------
SCHERBER HANNES. •eN VALLEY, INC.
68100 RAMON RD STE C10 �P. BOX 2263
CATHEDRAL CITY 2234 M SPRINGS CA 92263
L O 9 ioo4 W C:) 324-4507
EXEMPT
C: EXEMPT 07/31/05
B28407 12/31/05
CCC:
------------------------------
Permit e. . . BLDG POOL PERMIT
Additional desc
Permit Fee 162.00 Plan Check Fee 105.30
Issue Date . . . . Valuat-on . . . . 15000
.Qty Unit Charge Per Extension
BASE FEE 45.00
13.00 9.0000 THOU BLDG 2,001-25,000 117.00
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Permit MECH POOL
Additional desc
Permit Fee . . 24.00 Plan C neck Fee 6:00
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 9.0000 EA MECH FURNACE <=100.{ 9.00
-------------------------------------------------7--------------------------
Permit . . ELEC POOL PERMIT -RES
Additional desc
Permit Fee . . . . 45.00 Plan Caeck Fee 11.25
Issue Date . . . . Valuation. . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMQNG POOL 30.00
ELJ
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 011-5371 Date: _�-9' 6q
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
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 License is in full force and effect.
.cense Class iens
�L ce No.
—6erttr�or bo^✓i'O % �/� U✓
OWNER -BUILDER DECLA O
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.).
(--) 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. , BA 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 workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier 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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those pro ision^ss.. � v j %
,,--Date
74-&'e' ant l�D 1 P� (Z
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, D 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 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 information is correct. 1 agree to comply with all city and county ordinances and state laws relating'to building
construction, and hereby authorize representatives of this county enter upon the above-mentioned property for inspection/purposes.
Date 'd / Signature (Applicant or Agent):
Page 2
Application Number . . . . . 04-00005371 Date 7/07/04
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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
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Special Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALLr,BE IN
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Grand Total
Charged
264.00
130.80
394.80
Paid Creii-ted Due
---------- ---------- ----------
.00 .00 264.00
.00 .00 130.80
.00 .00 - 394.80
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CITY OF LA QUINTA SUB -CONTRACTOR LISTOB
,/IPT�
ADDRESS
PERMIT NUMBER OWNER BUILDERhis
form shall be posted on the job with the Building
Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
. on this job. Any changes to this list must be approved
by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of
work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed
by applicant. "On File" is not an acceptable response.
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Jul. 9. 2004 1:41PM Pacific Crest Mortgage
W100 Ramon Rd., C-10
Cathedral City, CA 82234
760-3244507
Fax.
12 Aul
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No.0761- P. 1
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Fax: ��Q (J ^ ZI 7— %O ll Pages:
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Re: PCC:
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