04-7601 (RPL)TAf 4 4:4",
BUILDING & SAFETY UtPARTMENT
P.O. BOX 1.504 (760):777-701:2
78-495 CALLE TAMPICO FAX (760) 777-7011
L,A QUINTA; CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
Application -Number . .
Property Address . . .
APN:
Application description
Property Zoning .'
Application valuation .
Owner
M/M HALES
78165 HACIENDA_
LA QUINTA CA
--Permit V
,
Additional desc A.
Permit Fee . . . .
Issue Date . . . .
BUILDING PERMIT
0°' . bate 12/09/04
A LA QUINTA
64,6-28;0-013- - -
. . POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
190;00
TO
Contractor
------------------
CALIFORNIA POOLS & SPAS
P.O. BOX 1280,
- COACHELLA CA 922:3 6
(� 7 6�0) 3-9�8 = 9:2 22
At�. WCC: STATE FUND
WC: 046000.61:168. 01/01/05
CSLB: 656128 10/31/06
CCC: C.8 -C27 -C29-05.3
PERMIT
198..00 Plan Check Fee . 128.70
Valuation . . . . '18840
Qty , Unit Charge Per Extension
BASE FEE 45.00
17.00 9.0000 THOU BLDG 2;001,-2 5,000 153.00
Permit . . . . . MECH POOL_
Additional.desc . . .
Permit Fee 24.0'.0 Plan Check Fee 6.0'0
Issue Date . . . Valuation 0
Qty Unit Charge,. Per Extension
BASE:FEE `15.00
1.0.0 9.0000 EA MECH.FURNACE <=LOOK 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
1.00 30.0',000 'EA ELEC PRIVATE ;SWIMMING, POOL 30.00
Permit.. . . . PLUMBING
Additional des.c .
Permit Fee . . . . 27.00 Plan Check Fee 6.75
Alp.,
P.O. SOX 1504 VOICE (760) 777-701.2
78-4.95 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA, 9225.3 INSPECTIONS (760) 77741.53
BUILDING &SAFETY DEPARTMENT
Application'Number: 0g- ?%v ( Date:
Applicant: I Architect or Engineer
Applicant's Mailing Address:
Architect or Engineer's Address:-
Lic, No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I f�ereby aifirm.under penaltyotiperjury that I am Itcensed,under provisions;of Chapter.9 (commencing with Sedlort.7000) ofQivision3 of the Business and Professionals
e;!and my. License is in full forces;and doffed.
nse Class rcense,No.-
Date ontractor
OWNER -BUILDER DECLARATION
I hereby affirm under Penalty of perjury that I am exempt fromthe Contractors' State L'Icense Law for the following.reason (Sec. 7031.5,'Bu5iness and Professions Coda: Any
city or county that requires a perrnitto construct,; alter, improve, demolish, or repair any srrxdure„prIor to he,lesuanoe, also .requires the.applicantfor the permit 16,69 a. signed
statement that he or she is'licensedursuant provisions of the Contactors! State License Lawess
(Chapter 9 (commencing with Section 7006):of Division 3:of#w,Busln
P.
and Professions Code or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5'byanyapplicant for a pemdt subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 1, as owner of the property, or, my.employees,with wages-.es1heir sole compenesoon, will do the work, and thestructure is not intended or offered for sale (Sec: 7044,
Business and'Professions Code: The Contractors' State License Law does not apply an owner of property who builds or improves thereas,,and who does the wo*
himseN or. homelf.or through his or her ownsmployees, provided that tha Improve haft are; notintended or offered for sale. K' however, the building.or improvement is
sold'within one year of completion, the owner builder will -have the burden of proviN that he or she did not build or improve for the purpose of sale.).
(�
1, asownerof the property, am exclusively contracting.with licensed contractors'to construct,the project'(Sec. 7044, Business and, Professions Code: The Contractors'
State License Lew does not apply to an owner of,property who builds or improves.thereon, and who contracts for the projects,with,a conhactogQ licensed pursuant to
the Contractors' StatoLlcense,Law.).
U Gam exempt under Sec: : BA P:C. for this reason
Date .Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of'thelollowing declarations:,
_ I have and will maintain. a certificate of, consent to self nsure for workers' compensagon; as provided for by Section 3700 of the Labor Code, for the performance.
of the work forwhich this permitis issued:
I have and will maintain workers' compensation Insurance, as.requirefty;Section 3 r C
700,of the Laboode, for the performance of the work for which this permit Is
issued. lily workers' oompensstlon i�6nce carrier,and policy number are:
artier iPolIcy Number
_ I oertYythat, in the performance - the;work for which this permit is issued, l shallnot employ eny'person Inanymanner soar, to become subjectto the workers'
compensation laws of California, and agree that; if 1, should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions:
iccant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGEIS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO.CRIMINALPENALTiES,AND
CIVIL FINES UP`TO ONE HUNDRED THOUSAND DOLLARS (s100,000),AN ADDITION TO THE COST OF'COMPENSATION, DAMAGES AS PROVIDED FORIN
SECTION 37011 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S' FEES.
CONSTRUCTION LENDING AGENCY
1 hereby affimrunder penalty of perjury thatthere is;a oonstnsction'lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lenders -Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANTApplication Whereby Made to the Director of Building and Safety for a perrnitsubjectto tha 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.benerrtwork is,Performed under or pursuantto any permit
issued as a result of this application, the owner, and -the applicant, each agrees to, and shall,, defend, indemnify and hold harmless the Cityof La Quints, its,
officers, agents and empigyees•for any act oromission related to the work being performed under or following issuance of this permit.
2.: Any permit Issued as aresult of this application becomes null and void if work is not commenced within 190 days from date of issuance of such permit, or
cessation of work for 180 days will^subject permit 0 cancalladon.
I certifythat I have read this;application and: state:.that the above information is -correct I agree to comply with;all'eHy and county ordinances and`state laws relating tobuhlding
construction, and hereby authorize representatives ofttps county to enter upon the above-mentioned property for inspection purposes.
to ignature (Applicant or Agent):
Page 2
Application Number . . . . . 04-000076,01
Date 12/09/04
Issue Date . . . Valuation
0
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 6.0000 EA - PLB FIXTURE
6.00
1.00 3;.0000 EA PLB WATER INST/ALT/REP
3.00
1.00 3. 0:'0,0 0 - EA PLB GAS PIPE 1-4 OUTLETS
Permit.WALL/FENCE PERMIT
Addition'aldes.c .
Permit Fee . . . . 15.0;0 Plan Check'Fee
.00
Issue Date . . . . Valuation . .
. . 260
Qty Unit Charge Per
Extension
.BASE FEE
15.00
----------------------------
Special 'Notes a -rid Comments
POOL. .12 L.F. 5' EQUIPMENT -ENCLOSURE,
CITY STANDARD. ALARMS BARRIERS SHALL'BE
IN PLACE PRIOR TO PREP,LASTER INSPECTION.
Fee summary Charged Paid Credited
Due
Permit Fee Total 3,0'9.00 .'00 .00'
309.00
Plan Check Total 152.70 .00 .00
152.70
Grand Total 46.1.70. .00 ,0'0
4,6'1.70