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04-5634 (RPL)T(.A(f 4 4 a" 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 . . . . . c -04==000056.3\4 - Property Address . . . . . . 43655 CALLE ESPADA APN: 609-580-004- - Applicat.ion description . . . POOL - RESIDENTIAL Property Zoning . . . . . LOW DENSITY RESIDENT Application valuation . . . . 18000 Owner PONDEROSA HOMES II, LLC 400 S. FARRELL DRIVE, B103 PALM SPRINGS, CA 92264 LA QUINTA CA 92253 Contractor CALIFORNIA PO Date 7/22/04 nn � IA� . �U 2 6 2004 CITY OF L A QUINTA FrAMWEDt O -PAS P.O. BOX 1280 COACHELLA (760) 398-9222 CA 92236 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 189.00 Plan Check Fee 122.85 Issue Date . . . . Valuation . . . . 18000 Qty Unit Charge Per Extension BASE FEE 45.00 16.0.0 9.0000 THOU BLDG 2,001-25,000 144.00 ---------------------------------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 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No. BUILDING PERMIT DECLARATIONS CENSED CONTRACTOR'S DECLARATION I here y affirm under penalty of perjury that I am licensed under ns of Chapter 9 (commencing with Section 7010 of Division 3 of the Business and Professionals C e, and my License is Lo fyll force and effect. s— rcense Class i n No. / Date ontractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from C tractors' 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.). U 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 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. Y -I have and will maintai orkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is �- iss d. worke ' compensatio ante carrier and/� lily�?umbe ar /Gamer Policy Number C v certify that, in the performance of the work for whic is pe 't 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, should be ome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith /co=.Iicant isions. /bate/ C (/4(v / WARNING: FAILURE TO SECURE WORKERS' COMPEU5ATIOL(ZOVERAGE 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 rN, Q Lender's Address 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 r quest and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicaaworks s , a she ,defend, indemnify and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission related tm pe ormed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null ans no commenced within 180 days from date of issuance of suchpermit. or cessation of work for 180 days will subject permit to cancella1 certify that I have read this application and state that the above ' rmatioagre to comply with all city and county ordinances and state laws relating to building construction, and hereebbyyyauthorizerepresentatives of this cou ty enter u -me boned property for inspection purposes. Aate Z� L JS nature (Applicant or Agent . I wo Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 291.00 .00 .00 291.00 Plan Check Total 148.35 .00 .00 148.35 Grand Total 439.35 .00 .00 439.35 4 Page 2 Application Number . . . . . 04-00005634 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, WATER FEATURE ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 291.00 .00 .00 291.00 Plan Check Total 148.35 .00 .00 148.35 Grand Total 439.35 .00 .00 439.35 4