04-4096 (RPL)T44f 4 4 09ha
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . . 04=00.0.04-0-96 Date 5/12/04
Property Address . . . . . . 53825 EISENHOWER DR
APN: 774-165-016-5 -000000-
Application description . . . POOL - RESIDENTIAL
Property Zoning . . . . . . COVE RESIDENTIAL
Application valuation . . . . 12000
Owner Contractor
------------------------ ---------------------L--
POWER FINANCE BRAUCKMANN INC
P.O. BOX 134 P O BOX 517
LA QUINTA CA 92253 LA QUINTA CA 92253
(760) 485-9269
WCC: EXEMPT
WC: EXEMPT 06/17/04
CSLB: 781834 07/31/04
CCC: B HIC 07/31/04
----------------------------------------------------------------------------
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 45.00
10.00 9.0000 THOU BLDG 2,001-25,000 90.00
-------------------=-----------------------------=---------------=----------
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
------------------------------7---------------------------------------------
Permit . . . . . . ELEC POOL PERMIT -RES
Additional desc
Permit Fee 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per e nsion
BASE FEE D Q 15.00
1.00 30.0000 EA ELEC.PRIVATE SWIM ON, POOL .30.00
MAY 2 12004
CITY OF LA QUINTA
P.O. Box 1504�� VOICE (760) 777-7012
Tdf
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: - Date:
Applicant:
Applicant's Mailing Address:
/) - .4 . h 4411_�
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License is in full force and effect.
icense Class License
Date
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt 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 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 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 ' Owner
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
issued. Myl��o�jer� compensation insurance carrier and policy number are: -Z C�
Cartier S+A-TE f f/A Policy Number / 7 J 3 6,
I certify that, in the performance of the work for which this permit is issue II not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if Ishould subied to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
{
forth fth comply with those provisions.
nye ✓ � l/ I/ Y .�i�,.�..r
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 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 request and 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 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 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 permit, or
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application 9nd state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter n the bov menf ned property for inspection purposes.
ate Z 6 ( gn.tur. (Applicant or Agent):
Page 2
Application Number . . . . . 04=00004096
Date 5/12/04
-----------------------------7----------------------------------------------
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. ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged Paid Credited
-----------------
Due
------------------------------
Permit Fee Total 237.00 .00 .00
----=-----
237.00
Plan Check Total 113.25 .00 .00
113.25
Grand Total 350.25 .00 .00
350.25
N
■■■I,
NEW
ME
��■■■IlIl■►p�
■■1-5 1!
1■Ms��■■I
■li�iil■■
-- IIMURIMM■■i
loom ILELIESEEM1
��
E16ALLQI RSA
NIGH POINT
6V LBO OPACNA
• �INN
IX �
�— �- —►.
'woo-cotwo
� Ix s -
MIK
O
;s,
W -V
I---
/
TYR
AC C0ND94M !ET
ON 4%W COMG PAD
4M-MYA"�-e
RE011IRt6 A
AeErERATa Pe"LA"M "mcncm
CITY OP A PL�LIC
TOP OM PAD TO OE
WCOM CWARTI-M-7 .
\
NOW
■r.MI
i►��i
■I`a
■
AOOM &RA •
D!
O
i&RAND
`
-'I
I
&RAVEL
a
e
L V -V
PAD
I:
mGmonl ;
1
%
1
.\
■■■I,
NEW
ME
��■■■IlIl■►p�
■■1-5 1!
1■Ms��■■I
■li�iil■■
-- IIMURIMM■■i
loom ILELIESEEM1
��
E16ALLQI RSA
iiva■i
6V LBO OPACNA
-
c
7-W L961W
-
!M Visa
O
;s,
El
f U 7!• aMCkPWJ L" IL0R1OW
A
(Kw PALO V"
4M-MYA"�-e
RE011IRt6 A
AeErERATa Pe"LA"M "mcncm
CITY OP A PL�LIC
i
WCOM CWARTI-M-7 .
NOW
■r.MI
i►��i
■I`a
■
N■■III
a
e
p -e
■TBACK 1
i -- POWM FINANCE ASS0CIA' U WQ . c
THOMAS >BUFFI1- PRES.
ml
;t SCOe\r
�I
TEDBTItEEtH�1
1._
49 GOW-Y 6EfiIL7LL Ra 1
N
wx CERCIDw RGItlDII� 1
1
�'Al" bCM
Af0 &YTTEI! � DAT1M PRINT
.pILJ 1p
GA C ` PAD PLOM0N IOIOIQI IWs•
tfV SSM R.00R TD OE B•
ACOVY DAnf1 POM AT TOP 0t
Ours AT C91TEPKM OP LOW
E16ALLQI RSA
6V LBO OPACNA
-
c
7-W L961W
-
!M Visa
O
;s,
El
f U 7!• aMCkPWJ L" IL0R1OW
A
(Kw PALO V"
4M-MYA"�-e
RE011IRt6 A
AeErERATa Pe"LA"M "mcncm
CITY OP A PL�LIC
i
WCOM CWARTI-M-7 .
1
�'Al" bCM
Af0 &YTTEI! � DAT1M PRINT
.pILJ 1p
GA C ` PAD PLOM0N IOIOIQI IWs•
tfV SSM R.00R TD OE B•
ACOVY DAnf1 POM AT TOP 0t
Ours AT C91TEPKM OP LOW
e
r
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
NO -EXCEPTIONS!
in
i
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
.FG'rl C N. + I I
d
-
c
tt
-
;s,
El
A
TAN[.L
e
r
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
NO -EXCEPTIONS!
in
i
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
.FG'rl C N. + I I