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04-5633 (RPL)T__- . df 444" P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . . . � 04-000. 05633_.-- Property Address . . . . . . 43620 CALLE ESPAD -- APN: 609-580-016- - Application description . . . POOL - RESIDENTIAL Property Zoning . . . . . LOW DENSITY RESIDE 4 Application valuation 17000 1 Owner PONDEROSA HOMES II, LLC 400 S. FARRELL DRIVE, B103 PALM SPRINGS, CA 92264 LA QUINTA CA 92253 Contractor -n AL JUS 2 6 2004 CITY ®+F LE�* QUINTA CALIFORNIA POOLS & SPAS P.O. BOX '12 8 0 COACHELLA CA 92236 (760) 398-9222 WCC: STATE FUND WC: 04600061168 01/01/05 CSLB: 656128 10/31/04 CCC: C8 -C27 -C29-053 -------------------------------- Permit . . .. . . . -------------------------------------------- BLDG POOL PERMIT Additional desc.. Permit Fee . . . 180.00 Plan Check Fee 117.00 Issue Date Valuation . . . . 16783 Qty Unit'Charge Per Extension BASE FEE 45.00 15.00 9.0000 THOU BLDG 2,001-25,000 135.00 ---------------------------------7------------------------------------------ Permit .. . . . . . MECH POOL Additional desc Permit Fee 24.00 Plan 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 P.O. BOX 1504 • '�C'�� 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: 56 3.3 Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.: A BUILDING PERMIT DECLARATIONS J_�rion D CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed us Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals C90e, and my Lic se ' II force and effect. rcense Class ",Date Z6! onl. or 1 <th. r�olt NER$U to Lic DECLARA710N 4 hereby affirm under penalty of perjury that I am exempt froCont dors'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, improish, 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.). U 1, 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 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 rkers'compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issu d. Myaorkers' mpensation in��ce carrier aP�goliry r}yr�p�rar�e• / Carrier �' iL{ /2 olid' cy Number i�`7C�C! L/U (� / J Cr7/� —I certify that in the performance of the work for which )jhis s 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 s uld be me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pro j§ions. / �fSte �iZG /1 pplicant WARNING: FAILURE TO SECURE WORRS' COMPS ATIO ERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THO SAND 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 1 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 ///]�.. Lenders Address i"T 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 d shall, defend, indemnity and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission related to the work in perfo ed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if w rk s not cam enced 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 co . I gree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this countyA enter upon a ov -mentioned property for inspection purposes. ature (Applicant or Agent): Application Number . . 04-00005633 Page 2 Date 7/22/04 Qty Unit Charge Per Extension 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 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, 10 L.F. 5' GARDEN WALL, CITY . STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION 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