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04-4062 (RPL)S BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7 15 3 BUILDING PERMIT Application Number . . . 04=00004062 Date 5/11/04 Property Address . . . . . 53885 EISENHOWER DR APN: 774-165-020-9 -000000- Application description . . POOL - RESIDENTIAL Property Zoning . . . . . . COVE RESIDENTIAL Application valuation . . . . 12000 Owner Contractor ------------------------ ------------------------ POWER FINANCE BRAUCKMANN INC P.O. BOX 134 P 0 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 . . . . . . 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 . . . . . . 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 2,001725,000 90.00 ---------------------------------------------------------------------------- Permit . . . . . . ELEC POOL PERMIT -RES Additional desc Permit -Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date Valuation . . . . 0 Qty Unit Charge Per fij���1 tension BASE FEE P 15.00 1.00 30.0000 EA ELEC.-PRIVATE SW �u IN+ ,,OO�I� 2004 30.00 CITY OF LA QUINTA P.O. BOX 1504 • dAroull VOICE (760) 777-1012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0 Date: 04 Applicant: Applicant's Mailing Address: 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 visions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Licen in full force and effect. n�lD incense Class License No. Date 5"'d-910VCon /e"Ad:o�l OWNER -BUILDER DECLARATION 1 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.). () 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 My wo erg compensation in a carrier d� j�(ic num r re: rier / AM -.4G - �1 // ' olicy Number ��� �DiiU I certify tKat, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall 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 ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 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.). Lenders Name 44 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, indemnity 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 pemdt. 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 pemrit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct I agree to comply with all city and county ordinances and state laws rotating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. ate G -0Signature (Applicant or Agent): _ 4aA . P.O. Box 1504�� VOICE (760) 777-7012 Tilf 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: Architect or Engineer: Architect or Engineer' dol e t___-.,,/ 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 Licen in full force and effect. License Class ens e N . Date —�—Z1OY Contractor 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 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 i su d M",o ers' compensation insurance carrier and policy number are: Carrier 52 f— � 14 Policy Number /-7-g3 _ I certify that, in the performance of the work for which this permit is issued. I s mploy any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I 7shbbe lect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthZy comply with those provisions. Date ZI Applicant 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, indemnity and hold harmless the City of La Ouinta, 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 and state that the above informati s core . I agree to com tt all and county ordinances and state laws relating to building construction, nd he by authorize representatives of this county to e r upon the erty for inspection purposes. Date J A/ o Signature (Applicant or Agent): 1 �I Page 2 Application Number . . . . . 04-00004062 Date 5/11/04 ---------------------------------------------------------------------------- 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 2.00 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 ONLY WITH HEATER. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER IN PECTIONS 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 9'4' WW BLOM WY NIGH POINT • W-Wl�IC! r —_ $_ YDOD 1s11Cs - wwo IX 4 r— TYR AC CON0814M TET / ON 47t4' CON1. PAD ® } MAV \ TOP CM PAD M OE EL AOOVTp dlt,lpE • i �� "AVa I �� v:7 r'w f''r i 4 PAD_ s■■I ■�■■1�■�■►0 1■Nss�■■ [OEM[Iti■mm■oo1 ' N -- - N it p%Q c%4 s h _ 'ul �■■i i ■ il e I I I I� I � WOOD r� I IMP7 191 � I I I 9'4' WW BLOM WY NIGH POINT • W-Wl�IC! r —_ $_ YDOD 1s11Cs - wwo IX 4 r— TYR AC CON0814M TET / ON 47t4' CON1. PAD ® } MAV \ TOP CM PAD M OE EL AOOVTp dlt,lpE • i �� "AVa I �� v:7 r'w f''r i 4 PAD_ s■■I ■�■■1�■�■►0 1■Nss�■■ [OEM[Iti■mm■oo1 ' N -- - N it p%Q c%4 s h _ 'ul �■■i i ■ il e POWER !FINANCE ' ASSOCIA7E8; INC. , THOMAS BUFFIN - PRES, >n CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED �FR0 NS i RUCT•IOi � DATE I O BYj� - { RE -INSPECTION FEE OF $30 I I -J � ILL BE J I'- - - CHARGEDIFTHEAPPROVED DIIW 1APFl.DAGIWWII 6A � �` ANS AND eEPE�wTa TSL Ago wPEcn,N T CARD ARE NOT ON MCM CRT OF LA QWA PAXIC JOB E SITE FOR A SCHEDULE 4,.m. } _ SPEC -TION. D r;ET aac NO EXCEPTIONS Ek16TfNG Ci/m A}O 6YTTE)l � DAfIM rOOiT ' l mom EHpuPAD i "AT04IpOTPOOTrIKfT /� ✓ OV = ' ,j r, J ABOVE AM FK MTO OA O•OP CP • �• CIMD AT CEiT04.66 O: LOTJ t IMP7 4_ �... V T1 ml , TED 81 EETe 0�-a VTE CL 0 i; fU 24• Box cvw4mm r -mourn El ON GAUAN MWAM T" <= ' 6W LM tWACM 74jr 186TW } iiiML WJW O (1) �!• EtODt CCI�CIDNi KOIEOMEI (BWE PALO ViRDW i I - � I ''..1 POWER !FINANCE ' ASSOCIA7E8; INC. , THOMAS BUFFIN - PRES, >n CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED �FR0 NS i RUCT•IOi � DATE I O BYj� - { RE -INSPECTION FEE OF $30 I I -J � ILL BE J I'- - - CHARGEDIFTHEAPPROVED DIIW 1APFl.DAGIWWII 6A � �` ANS AND eEPE�wTa TSL Ago wPEcn,N T CARD ARE NOT ON MCM CRT OF LA QWA PAXIC JOB E SITE FOR A SCHEDULE 4,.m. } _ SPEC -TION. D r;ET aac NO EXCEPTIONS Ek16TfNG Ci/m A}O 6YTTE)l � DAfIM rOOiT ' l mom EHpuPAD i "AT04IpOTPOOTrIKfT /� ✓ OV = ' ,j r, J ABOVE AM FK MTO OA O•OP CP • �• CIMD AT CEiT04.66 O: LOTJ t