04-6478 (RPL)f
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760) .777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92'253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number .'. _ . . 04-0.0006478 Date 9/28/04
Property Address . . . . 48780-EI'SENHOWER DR
APN: 658 -310 -019 -
Application description.. POOL - RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation... 12000
Owner Contractor
SAMMIS CALIFORNIA POOLS &SPAS
48780 EISENHOWER DRIVE P.O. BOX 1280'
LA QUINTA CA 92,253 COACHELLA CA 92.236
(760) 3.98-9222
WCC: STATE .FUND
WC: 04600061.168 01/01/05
CSLB: 656128 10/31/04
CCC: C8 -C27 -C29 -.C53
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee . . . . 135•.00 Plan Check Fee 87.75
Issue. Date Valuation 12000
Qty Unit Charge Per Extension
BASE FEE 45.0,0
10.00 9:0000 THOU .BLDG 2,001-25,000 90.0,0
Permit MECH POOL
Additional desc .
Permit Fee . . . . 24:0.0 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
BASE FEE
1.00 30.0000 EA ELEC. PRIVATE S
ion
. 00
.00
P.O. Box 1504 4"'
VOICE (760) 777-7012
78-495 CALLS: TAMPICU Todf 4 4 FAX (760) 777-7011
LA QVINTA, CALIFORNIA 42253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 04- (0478 Date: OL040• O q
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address: -
Lic. No.:
P/,4
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTORS' DECLARATION
I hereby affirm under penalty of perjury that I am licensed under visions of Chapter 9 (commending with Section 2000) of Division 3 of V Business.and Professionals
and my, Ligelse�i r+ 1�Lforce. and effect. / O�
u�ense Class' f No v��Q
/0 4, ,0 n�tractor
OWNER43UIL.DER DECLARATION
1 hereby affirm under penalty of perjury that I am exemptfrom the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Pmisssions code: Any
city or county that requires a permil.Oo construct atter, improve, demolish, or repair any structure. prior m 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 ptlegW 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 worts, and the structure Is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractors' State License Low 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 construotthe project (Sea 7044, Business and Professions Code: The Contractors'
State.License Law does not apply'to an owner -of property who buflds.or improves thereon, and who contracts for the projects with a contractar(sy licensed pursuant to
the Contractors' State License Law.).
U 1 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:
1 have and will maintain a certificate of consent tmself-insure for workers' compensation„as providedlor by Section 3700 of the Labor Code, for the performance
of the work for which this, permit is issued.
have -and will maintain rkers' compensatio insurance, as required by Section 3700 of the Labor Code. for the: performance of the work.far which this pemdt is
iss works m nso ' nce cario� @ryd pgt+cy{+y�+ber app ! �+�
Carrier] 4ALI-' !�I olicvNumber r/�/ dCJC, (9 i�L7 X
_ I car* that, in the perfornance;of the work for whichlbis pemstis issued. I shall not employ any person in any manner so as to become subject to the.workers'
compensation laws of California, and agree I sh become subject to the workers' compensation provisions of Section 3700 o1 the Labor Code. I shag
forthwith comply with those provisions.
WARNING: FAILURE TO SECURE' WORKERS, COMPENSATION COVERAGE 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 ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm.under penalty of perjury that there is,a construction.lending egency:for the performance of the work for which this permit is issued (Sec. 3097,'Civ. C.).
Lenders Name
lenders 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 applicatioKis made, each person at whose request and for whose benefitwork is perfommed under or puntuent to any permit
issued as a result of this application, the owner, and the applicant, each agrees to. and shall, defend„ indemnify and hold hareless1he Clty of La Quints, ftofficers, agents and.empfoyees for any act or omission related to the work being performed under or following issuance of this pemdt.
2. Any permitissued as a result,of1his application becomes null and void ifnot commenced within 180 days from date of issuance of such permit, or
cessation -of work for 180 days`will subject permit.to cencellation.
1 certify thaYI he” read this application and state that.the above information isto comply with ,all city and county ordinances and.state laws relating to buliding
construction, and hereby authorize representatives of this county)d-"rupoq 1 tinned property for inspection purposes.
ate .O10 ig�5` nature(ApplicantorAgent):
Page 2
Application Number 04-00:006478
Date 9/28/04
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Permit . . . . . . PLUMBING
Additional desc . . `
Permit Fee . . . . 27.00 Plan Check Fee
6.75
Issue Date . . . . Valuation . .
. . 0
Qty Unit Charge Pet
Extension
BASE FEE
15.00
1.00 6.0000 EA PLB FIXTURE
6.00
1.010 3.0000 EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
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Special Notes and Comments
ADD SPA & RE -PLUMB AND ADD NEW POOL
EQUIPMENT. ALARMS/BARRIERS SHALL BE IN'
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited
Due
Permit Fee Total 231.00 .00 .00
231.00
Plan Check Total 111.75 .00 .00
111.75
Grand Total 342.75 .00 .00
342.75