04-6629 (RPL)BUILDING.& SAFETY DEPARTMENT
P.O._ Box 1504 (760).777-70:12
78-495 CALLE TAMPICo FAX (760) 777=7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING. PERMIT
Application Number 04-00006629 Date 10/05/04.
Property.Address. 43509 CALLE ESPADA
..APN: 60.9-580-011- - -
Applica.tion.description:. POOL = RESIDENTIAL
Property Zoning . . . LOW DENSITY RESIDENTIAL
Application valuation.. 17000
Owner. Contractor
PONDEROSA HOMES II, LLC-: CALIFORNIA POOLS & SPAS
400 S. FARRELL DRIVE, B103. P.O. BOX ..1280
PALM. -SPRINGS, CA 92264 COACHELLA. CA 9223'6 -
LA QUINTA.. CA 92253.. (760) 398-9222...
WCC: STATE FUND:..
WC: 04600061'168 Q1/01/05
CSLB; 65.6128.. 1.0/31/04.
CCC C8 -C27 -C29-053
Permit MECH POOL
Additional desc
Permit.Fee 24.00 P1ari Check Fee 6.00
Issue Date Valuation 0
Qty Unit Charge Per Extension
- BASE. FE& .. 15.00
1:.00 9.0000 EA MECH FURNACE <-100K 9:00
.Permit BLDG POOL PERMIT
Additional desc
Permit Fee 180.00 Plan Check.Fee• 117.00
Issue. Date .Valuation 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. :Fee 11'.. 2.5
Issue Date Valuation 0
Qty= U Charge Per,Extension
BASE. FEE 15..00
U
P.O. Box 1504
• ��1V��7 N
78-495 CALLE TAMPICO w
LA QUINTA, CALIFORNIA 92253
Application Number
Applicant:
Mailing Addeess:
BUILDING & SAFETY DEPARTMENT
Architect or Engineer.
VOICE (760) 7.77-7012
: FAX (760) 777-7011
INSPECTION$ (760) 777-7153
Date: f 0 • (o .0(/,
Architect or Engineer's
1-ic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penaltyofpe*xy 0* 1 an kensed under provision$ of Chapter 9 (oomsncing with Section 7000) of Division 3 of the-BusYass and
�Profassbnss
Code. and my C 5 tape and affect 6,56 /.? $
License Class License No.
Date % d Catradtor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury VM I am exempt from to Contractors! State License Lave for the Mowing reason (Sec. 7031 b. Business and Profession$ Code: Any
city or county that regrires a permit to construct, atter. l rprovo, demolish, or repair any struckm prior to Ib hwAv xk aso requires the applicant for the permit lo IOe • signed
statement that to or she Is lloar$ed pursuant to On provisions of the ContrmcloW State License Law (Chapter 9 (convnbndng with Section T000) of Division 3 of the Business
and Professions Cole) or that he or she Is exempt ttwmfrom and the bass for the alleged exemption. Any violation of Section T031.5 by any applicant for a permit subjects
the applicant to a dvi penalty of not mora than five hundred doom (Ssw0 r
U 1, as owner of tib property. or my employees with wages as their sole cortpar$adon, wl0 do ttb work, and tie structure is not Intended or offered for sale (Sec 7044.
Busk»ss and Professions Code: The Cw**dW State License Law does not appy to an owner of property who builds or knprovet: ttmaeor►, and who Was the work
himself or herself or through his or her own employees. provided that the improvements ars not Intended or offered for sate. If. however. the building or Improvement Is
sold within one year of completion, tib owner4Ader will have the burden of provtrq that he or she slid not build or improve for the purpose of sob.}
(, 1. as owner of the property. am exclusively contras ing with licensed contractors to construct to project (Sec. 7044. Business and Professions Code. The Cortrad0rs'
State License Law does not appy to on owner of property who builds or Improves tiereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contras State License lour.).
(� I am exempt under Sec. B.S PA. for this reason >`
nate Ownerj�•. � .
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 *elfansura for worker*' a a ill - ft% as provided for by Section 3700 of the labor Code. fort n parkmiance
of the work for which this permit Is issued.
;� I have and will maintain workers' compensation Insurance, as mqudred by'Section 3700 of the Labor Code, for the �periomnance of the work for which this permit s
we� My oomQensatlon.lAsurance carrier and policy�ymbar aro:
Cartier tP A �. Policy Number D y(orJ/�i
l. certify that. In the performance of the worn for which this permit Is issued. I stall not employ any person In any me~ so as to become subject to the wakes'
cormmpensation laws of California, and agree that, if I should become subject logo workers' compensation provisions of Section 3700 of the Labor Code, i *hap
forth*ft comply with those s.
Dated/ (� p pppcant ,
WARNING: FAILURE TO SECURE WORKERS' C SATION COVERAGE IS UNLAWFUL, ASHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FiNE$ UP TO ONE HUNDRED THOUSAND DOLLARS ND (5100.000). W 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 two is a construction lending agency for the performance of the work for which this permit Is Issued (Sea 309T. Civ. C.).
Lenders Name
Lenders 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 appOCa0o(m.
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 10 any permit
Issued as a result of fts sppk atiM the owner. and the applicant, each agrees to, and ". defend, indemnify nify and hold harmless the City of La. tlkArta, its
offioers, agents and employees for any ad or omission related to the oak being performed under or following Issuance of this permit.
2 Any permit Issued as a result of this apppcatbn becomes null and void ff not commenced within 460 days from dada of Issuance of such pemdt, or
cessation dmf work for 160 days will subject permit lo cance0at(on.
I Certify that I have road this application and state that the above ton s I lo comply with ail city and county ordinanoea and state laws relating lo Wilding
construction. and hereby authorize representatives o this county enter toned property for Inspection purposes.
Date! d Signature (Applicant of Apenq:
Application Number
I
. . . . . 04-00006629
Page. 2
Date 10/05/04
Qty Unit Charge Per
Extension
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL
30.00
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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 SHALL BE IN
PLACE PRIOR TO PREPLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED IN
PERMIT.
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 282.00 .00 .00.-.
282.00
Plan Check Total 142.50' .00 .00
142.50
Grand Total 424.50 .00 .00
424.50