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04-5930 (RPL)P Tar 4 BUILDING & SAFETY DEPARTMENT P.O. 14504 (760)777-7012 F9 �� 449 LLE, TAMPICO FAX (760) 777-7011 �uG LA NT. CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153' �� ®1J1Nrt9► BUILDING PERMIT Application Number 04-00'00'5930 Daae 8/13/04 Property Address . . . 79917 HANCOCK CT APN: 604.=492-0.10-2.1 -24197 - Application description . . . POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application- valuation 20,000 Owner Contractor -------------------- MATT & CARRIE KOTZ BRYAN INVESTMENTS GROUP, INC. 799.17 HANCOCK COURT 393.01 BADGER STREET; #.2'00 LA QUIN.TA CA 92253 PALM DESERT I, CA 92:211 WCC: STATE FUND WC: 0009076:2003 03/29/05 CSLB: 55'2.140 06/3,0/06 CCC: B-053 Permit BLDG,POOL PERMIT Additional desc . Permit Fee 20*7.00. Plan Check Fee 134.55 Issue Date . . . . Valuation . . 200:00 Qty Unit Charge Per Extension BASE FEE 45.00 18.00 .9.0000 THOU BLDG•2,001-25,000 162.00 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-R."ES Additional desc .Permit Fee . . . . 45.00 Plan Check Fee 11.,2.5 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.0.0 30.0000 EA ELEC PRIVATE SWIMMING POOL 3:0.00 P.O. Box 1504 -VOICE (760) 777-7012 7,8-495 CALLE TAMPICO Tur444"FAX (760) 777-7011 LA ,QUINTA, CALIFORNIA 9.2253 INSPECTION'S (760,) 7774153 BUILDING' & SAFETY DEPARTMENT Application Number: O!q - Date: Applicant: Architect or Engineer: Applicant's,Mailin.g Address: Architect or, Engineer's Address: tic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOW&DECLARATION Thereby affirm under penalty of perjury that am licensed under provisions of Chapter�9f (comma ng with'Section 7000) of Division;3�of the Business and Professionals Code, and my Liters 's:i II t r and effect. �foense,Class ene.No. 'f tractor OWNER -BUILDER DECLARATION ['hereby affirm under penalty of perjury, that.l am.exempf from the Contractors' State; License Law 'for the following reason (Sec. 7031.5,: Business5and, Professions Coder Any city or county, that requires a permit to construct, alter, improve; demolish, orrepalr any structure, prior to its issuance, also _requires.the:epplicantfofi 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 therefiom:and the basis for the alleged exemption., Any, violation of -Section 7031.5 by any applicant fora permit'subjects the applicant to a civil penally 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'ProfessionsCode: The Contractors' State License1aw 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 101anded'or offered for said: If, however; the building or Improvement is sold ,within one year of completion,, the owner -builder will have the burden of proving that Nor she did not build orImprove .foc 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 ownerof property who builds -or improvesahereon, and who contracts for the projects with a contractors) licensed pursuant.to thecontractors' State.License Law.). U" I am exempt under Sec: B.& P.C. for this reason Date WORKERS' COMPENSATION DECLARATION I hereby affimi.under penalty of,perjury one of the following declarations: _ 1 have and will maintain a certificatwof consent to self insure:lor workers' compensation, as provided forbySection 3700 of the Labor Code:.for the performance' of the work for which this perrnitis issued. 1 have:and will maintain workers' compensation insuranoe; as required'bySection 3700 of the Labor Code, for the performance of the work forwhich this permit is sue . My w rs' co ensation i ce tamer a�nd,�. °Iicyyyuur�b9L� �7 arrier olicy Number M Y O /� - '[ _ I certify,that,in a performance of the work for which this permit is Issued, I shall not empAny`person Ircany manner so as to become subject to the workers' compensation laws of California, and agree that; if l should become subject to'the workers' compensation provisions.of Section 3700 of the, Labor Code, I shall forthwith comply with'those provisions. WARNING: FAILURE TOSEGURE WO E S' COMPENSATION` COVERAGE IS UNLAWFUL, ANOSHALLSUBJECT AN EMPLOYER TO CRIMINAL, PENALTIES AND CIVIL FINES.UP TO ONE HUNDREDTH WOVE ($100,000),1N ADDITION'T_ O THE CAST OF'COMPENSATION„DAMAGES.AS PROVIDED FORIN SECTION 3700 OF THE LABOR CODE, I REST, AND ATTORNEY'S_ ,FEES: CONSTRUCTION.LENDING AGENCY I hereby affirm under penalty of perjurythatthere is:a.construction lending agency for the�performance of the work for which this per itis issued (Sec;,3097, Civ: C.). LendersName A Lenders Address ` APPLICANT ACKNOWLEDGEMENT IMPORTANT Application 1whereby made to the DirectorotBuilding and',Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf -this application, i& made; each person at whose request for whose benefit work is performed under or pursuant,to'any permit Issued as.a resultof 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 We permit. 2 Any,pernit issued as a result of this•application'becomes null and void if work lis not;commenced within 180 daystrom date of issuance of such permit or cessation of work for 180 days will,subject psrmitto. cancellation. I certify that 1 have read this application and,state that the above information is correct I agrewto,comply with all city "and'eounty ordinances and state laws relating to'building construction, and hereby authorize representativesof tl is county to enter upon the above-mentioned property for inspecctieon.purposes. ig'nature (Applicant . or Agent): 9- L44 Page 2 Application Number . . . . . 04-00005930 Date 8/13/04 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 2.0"0 6:00.00 EA PLB FIXTURE' 12.00 1.00 3:0.0.00 'EA PLB WATER INST/ALT/REP 3.00 1..00 3.0000 EA PLB GASPIPE 1-4 OUTLETS 3.00 Special Notes and Comments POOL/SPA. ALARMS/BARRIERS SHALL BE IN PLACE AT -PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee summary Charged. Paid Credited Due Permit Fee Total 309.0"0 .00 .00 309..00 Plan Check Total 160.05 .00 .00 160.05 Grand Total 469.05 .00 .00 469.05