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04-4120 (RPL)Tiht 4 4QuAra BUILDING& SAFETY DEPARTMENT P.O. BOX 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153 BUILDING PERMIT Application Number . . . . . Property Address . . . . . APN: Application description . . . Property Zoning . . . . . . . Application valuation 047-00004120 _ Date 7 -8925 -GALAXY DR 609-560-034-34 -23773 - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 15000 5/14/04 Owner Contractor ------------------------ --------- -------------- SEUSS MEREDITH J FAMILY POOL CONSTRUCTION 78925 GALAXY 53300 AVENIDA RAMIREZ LA QUINTA 9225 LA QUINTA CA 92253 D p (760) 564-3655 WCC: STATE FUND MAy 14 2004 WC: 1340322004 03/01/05 CSLB: 658996 11/30/04 C1nofLptQUKTA CCC: C53-HIC - ----------- - - - -------r1y�?pP7_--- 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 15.0'0 1.00 9.0000 EA MECH FURNACE <=100K 9.00• ---------------------------------------------------------------------------- Permit . . . BLDG POOL PERMIT Additional desc Permit Fee 162.00 -Plan Check Fee 105.3.0 Issue Date . . . . Valuation . . . . 15000 Qty- Unit Charge Per Extension BASE FEE 45.00 13.00 9.0000 THOU BLDG 2,001-25,000 117.00 ---------------------------------------------------------------------------- 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 P.O. Box 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA. 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: I hereby affirm under penalty of perjury that I am �de. an Cod my, License is and and effect. 'icense'Class � Date .� Contractors Date: Architect or Engineer: Architect or Lic. No.. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION under provisions of C apter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals icense No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exe pt 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 ft 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 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 ��..,�,� a wo co ensation insurance carrier and q i y ur rare: YCarriei �t�w `� Policy N ber ZIJ —I ertithat, in the performance of the work r which this issued, I shall not 6mploy any person in any manner so as to become subject to the workers' compensation laws of California, and agr a I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall fo G' comply with those provisi N0 Date / / Applicant IF 7 WARNING: FAILURE TO SECURE WORKERS' COM NSATIO OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DO RS ($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 wWesCand 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 s to, and shall, defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission d t ork being performed under or following issuance of this permit. 2. Any permit issued as a result of this application become 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 n ella on. 1 certify that I N ve (0 id this application and state that the int on is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction by uthorize representatives of this county t n the above-mentioned property for inspection purposes. Date Signature (Applicant or Agent): 0 Page 2 Application Number . . . . . 04-00004120 Date 5/14/04 ---------------------------------------------------------------------------- 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'ONLY. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. Fee summary. Charged ----------------- Paid Credited Due ---------- Permit Fee Total ---------- •264.00 ---------- .00 .00 ---------- 264.00 Plan Check Total 130.80 .00 .00 130.80 .Grand Total 394.80 .00, .00 394.80 5005 /70MF 7892�t1LhXY 57-A1ZU6tlT DUNS CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION Ply- -7892 ly S-�-o IG�G Ya/rmdve, Y&,&L Construction' P00/5 5pa5 Foud ain5 L/C, #6S8996 t 5005 /70MF 7892�t1LhXY 57-A1ZU6tlT DUNS CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION Ply- -7892 ly S-�-o IG�G Ya/rmdve, Y&,&L Construction' P00/5 5pa5 Foud ain5 L/C, #6S8996