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04-4985 (RPL)0 0 BUILDING & SAFETY DEPARTMENT R -O. Box 1504. (760j 777-7012 C�. say 99i . CALLE TAMPIC.O FAX (760) 777-7011 LU QUINTA•, CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153 ' JN 212004 BUILDING PERMIT CITY OF (A QUI NTA Application Number 04-0.0004985 Date 6/15/04 Property Address . . . .5'4030 EISENHOWER DR . APN:. 774-221-026-24 .=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) 4857926.9 WCC: STATE FUND WC: ,17.337.852003 08/01/.04 C$LB: 781834 07/31/04 CCC': B. Permit MECH POOL Additional desc . Permit Fee 24.00 Plan Check.Fee 6..00, Issue Date Valuation 0 Qty Unit Charge aPer. Extension BASE FEE15.00 1.00 9.0000 EA MECH FURNACE <=100K 9:00 ------------- -------- 7 ----------- 7 --- 7 --- I ------ 7 --- 7 -----------=----------- Permit... BLDG POOL .PERMIT Additional desc Permit Fee 135.00 Plan Check Fee 87.75 Issue Date Valuation 12000 Qt.y. Unit.Charge Per Extension BASE FEE 45.00 1.0.00 9.0000 THOU BLDG'2,001-25,000 90..00 ----------- Permit..' . . . ELEC POOL PERMIT -RES Additionaldesc Permit Fee 45.00 Plan Check Fee 11.25 Issue Date Valuation 0 Qty Unit Charge Per. Extension BASE FEE 15.00 1.00 304000 EA. ELEC PRIVATE SWIMMING POOL. 30.00 P.O. Box 1504 • VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760)'777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: 'a - d Applicant: . Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Ad es . Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that.I am licensed under provislons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals 'Code, and my Lir se is in full force and effect, License Class Lice e N . Date (0 Z/ 16 Contractor OWNER43UILDER 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 pernif 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).): ( j 1, 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 1, 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. B.& P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of periury one of the following declarations:. I have and will ma)ntain 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 m sued. My�oj�ers' ompensation insurance came end policy r a : Cartier "f�� _lel . W - Policy Number / '7. �?,r ZOO I certify that, in the performance of the work for which this p6milt Is lesued, I sha I not employ.any person in any -manner so as to become subject to the workers' compensation laws of California, and agree that, IfI s ould become subject -workers' compensation provisions of Section 3700 of the Labor Code, I shall oRhwi comply with those provisions. Date �Z G Applicant WARNING: FA LURE 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 3708 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 Quirta, 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 infornatio wrrecl I agree to comply with II -city and county ordinances and state laws relating to building construction, ap he by authorize representatives of this county to an u n the above °elm a party for Inspection purposes. Date D ' Signature (Applicant or Agent): fm Page 2 Application Number 04=00004985 Date 6/15/04 ------ --------------------------------------------------------------------- Permit . . . PLUMBING Additional desc . Permit Fee 27.00 Plan Check Fee 6.75 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 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ------------------------------------------------------------=--------------- Special Notes and Comments POOL ONLY. ALARMS BARRIERS SHALL BE IN. PLACE PRIOR TO PREPLASTER INSPECTION. Fee summary - ---------------- Permit Fee Total Plan Check Total Grand Total Charged 231.00 111 75 342.75 Paid .00 .00 .00 Credited Due .00 231.00. .00 111'.75 .00 342.75 fl,4, Ai *\'1311 j Fm• ��'' _ T 7 n twig L r SETBACK a 15' /; V HIGH POINT deoMoo M� 'I SETBACK 5 •`v i - - A Rf-INSPECTION FEE OF $30 ®F QU7DEPT. WILL BE CHARGED IF THE APPROVED BUILDING & SAFETY ��. PLANS AND JOB CARD ARE NOT ON >, SITE FOR A SC ED" FO C Tr!E SI _ I -!`Ly I: L..� (� INSrr "Ti (-O'0 --6-Y DATE • I _�I \e ' \ i�7-- - -----moi I. !, ° 4too 1 Fm• ��'' _ T 7 n twig L r SETBACK a 15' /; V HIGH POINT deoMoo M� 'I SETBACK 5 •`v i - - A Rf-INSPECTION FEE OF $30 ®F QU7DEPT. WILL BE CHARGED IF THE APPROVED BUILDING & SAFETY ��. PLANS AND JOB CARD ARE NOT ON >, SITE FOR A SC ED" FO C Tr!E SI _ I -!`Ly I: L..� (� INSrr "Ti (-O'0 --6-Y DATE I _�I \e i�7-- - -----moi I. Fm• ��'' _ T 7 n twig L r SETBACK a 15' /; V HIGH POINT deoMoo M� 'I SETBACK 5 •`v i - - A Rf-INSPECTION FEE OF $30 ®F QU7DEPT. WILL BE CHARGED IF THE APPROVED BUILDING & SAFETY ��. PLANS AND JOB CARD ARE NOT ON >, SITE FOR A SC ED" FO C Tr!E SI _ I -!`Ly I: L..� (� INSrr "Ti (-O'0 --6-Y DATE