04-7930 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:.
Applicant:
CD;4=000�07930�
79778 HEMINGS WY
604-520-02.0-2.0 -24197
POOL - RESIDENTIAL
LOW DENSITYRESIDENTIAL
2.5000
Architect or
c&,ht 4 44"
BUILDING & SAFETY.DEPARTMENT
BUILDING PERMIT
D a
�, DEC 2 2 20 i t
CITY OF LA QUINTA
FflVANCE DEPT.
Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penaltyof perjury that I am licensed under: provisions of Chapter 9,(corrimencing,with
Section 7000)'of Division 3 of,ths Bu and 'Pr ofessionais Code, and my License is in full force and,effect.
Lcense�cla : C53 LicenseNo.: 672850
t/Z ontrector:, �
OWN IL ER DECLARATION
fherebyaffirm under penalty'of perjury that ham axe. fr the Contractor's State License Law for the,
following reasow(Sec.7031:6„Business and Fir essi e: Any. city or county that requires a,permit to
construct; atter, 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 theConiractor's State
L.icense'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 -(8600)::'
(_ 1 I, as ownerofthe,property, or my employees with', wages as ,their sole compensation, will do.the work; and
the structure isnot intended or offered for sale (Sec: 7044, Businessrand 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 through his or her own employees, provided that.the
improvements are'not intended or offered for sale. If, however; the building.orimprovementis 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;l..
I—) 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.eontractor(s) licensed
,pursuant to the
Contra
State License.LawJ.
I—) 1 am exempt under Sec. - , B.&P.C. for this reason
Date
Owner:
CONSTRUCTION LENDING AGENCY
I hereby offirm,under penalty of perjury that.there'is a construction_lending agency for:the performance of the.
-work•for whichtthispermitis issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
L.QPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
,INSPECTIONS (760) 777-7153
Date: 12/21/04
Owner:
MIKE DRUM
79778 HEMINGS WAY
LA QUINTA, CA 92253
Contractor:
GATTUSO POOL CORPORATION
667 S. EUGENE ROAD
PALM SPRINGS, CA 9.2264
(760;)327-7592
Lic. No.: 672850
------------------
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury -one of the following declarations:
_ rhave,and will maintain eosrtfficate_of,consent.to self -insure for workers' compensation, *as provided:
for by Section 3700,of the Labor,Cods, for the performanoe:of the'work forr which this parmit, 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 forwhich,this;perrnit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Pclicv Number 161507404
_ [certify that,:in the performanos,of the work for which this permit is issued, I shall not employ any
person In any manner so'as-to become subjectao the, workers'' compensation laws of _California,
and agree that, if I shouldbecome subject to the workers' compensation provisions of Section.
3700 of !a aborCode, II forthwith comply.with those provisions.
it a LZ pplicant: -
WARNING: FAILURE TO:SECURE WORKERS' COMPSN COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (8100;000). IN,ADDITION TO THE CO COMPENSATION, DAMAGES,AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST D AT
FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application Whereby 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 permjtissued as a result of this Lapplication,
the owner, and:the applicant„each, agrees to;.and,shall,defend, indemnify and'hol0armless the City
of La Ouinta, its officers, agents and employees for any actor omission related to thwwork'being
performed under or following; issuance of this permit.
2. Any permit issued as a result of this application becomes -null -and void if work is not commenced
within 180 days from date of issuance of such permlt, or cessation of. work for 180 days will subject
permit to cancellation.,
I certify that 1 haveread this applicatiowand state that the above Information is correct: I agree to comply with -al
city and;eo ntyordinenoes and state laws'relatin building construction; -and hereby authorize representatives
of this copy to enter upon above -mention party for inspection purposes.
�,1 1, ignature (Applicant or Agen j:
y�4,
Application Number . . . 04-0000793D
Permit'
BLDG POOL PERMIT
Additional desc .
Permit Fee . . .
252:00 Plan Check Fee
163:'80
Issue Date . . .
Valuation
25000
Qty Unit Charge.
Per
Extension
BASE FEE
45.00
23.00 9.0000
THOU BLDG 2,001-25,000
207.00
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
PermitELEC
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
PermitPLU_MBING__
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
12.0.0
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.. ALARMS/BARRIERS
SHALL BE IN
PLACE AT PRE -PLASTER
INSP.•ECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited
Due
----------------------
Permit Fee Total
------------------------------
354.00 .00 .00
354.00
Plan Check Total
189.3.0 .00 .00
189.30
Grand Total,
543.30 ..00 .00
543.30
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MIKE-
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LAso.CBvlwtZl� , GA 9`��3
GAITUSO POOL CORP
667 EUGENE ROAD
PALM SPRINGS, CA,92264'
p �r•G F- � l'-�
CITY OF LA QUINTA
BUILDING & SAFETY
DEPT. PT.
APPROVED
FOR CONSTRUCTION
Wy