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05-0076 (RPL)a, 10, � o BUILDING & SAFETY DEPARTMENT Cw4 . P.O. BO 4. . (760),777-7012 7895 C TAMPICO FAX (760) 777-7011 D UINT ALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 SAN 13 2005 BUILDING PERMIT CI Y OF LA QUINTA z _ - App i atf er C005 00_QOy07l z6 Date 1/11/05 Pro arty Address . . . . 81360 LEGENDSy-WY APN: 762 -420 -006 - Application description . . . POOL - RESIDENTIAL Property Zoning . . . . . . LOW DENSITY RESIDENTIAL Application valuation 18000 Owner Contractor --------------------------------- --------------------------------- TOLL BROS CALIFORNIA{ POOLS & SPAS P.O. BOX 1280 COACHELLA, CA 92236 (760)398-9222 WCC: STATE FUND WC: BB10S0510 01/01/06 CSLB: 656128 10/31/06 CCC: C8-C27-C29-053 -------------=-------------------------------------------------------------- i P.O. Box 1504 • '�C�� QU VOICE (760) 777-7012 78-495CALLS O FAX (760) 777-7011 LA [NTA, CALIFORNIAFOR 92253 4V INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 05 -7 (oDate: l' Z02-OY Applicant: I Architect or Engineer - Applicant's Applicant's Mailing Address: . Architect or Engineer; s Address: Lic. No. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licen:=o. visions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code,. and my Lice se is' fug force and effect. �nse Class �S _Vy l Zi5 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 fora 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 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. have and will maintain rkers' compensa ' insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is iss worke mpensation ' rance carrier and,..pf yli y n m��ieer a G arrier --policy Number �UD �f _ I certify t at, in the performance of the work for Inipermitis issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree tould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those proviAns. Date Z 5 Appli WARNING: FAILURE TO SECURE WORKERS' CO ENSAT ON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND D ($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 t Lender's Address 0 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 bei performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if wo is mmenced 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 information is correct. agree to reply with all city and county ordinances and state laws relating to building construction, an/he by authoriz e representatives of this county to err upon a ab v men ' ed property for inspection purposes. Date (Applicant or Agent): / ---------------------------------------------------------------------------- ' Application Number . ._ . . 05-00000076 ---------------------------------------------------------------------------- Permit . . . . . . BLDG POOL PERMIT Additional-desc .• � . . ., .. Permit Fee . . . . 189.00 Plan Check Fee 122.85 Issue Date . . . . Valuation 17920 Qty Unit Charge Per Extension BASE FEE 45.00 16.00 9.0000 THOU BLDG 2,001-25,000 ---------------------------------------------------------------------------- 144.00 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 Permit . . . . ... ELEC 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 --------------- 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 Permit . . . . . . WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date Valuation . . . . 80 Qty Unit Charge Per Extension BASE FEE 15.00 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -.r - - - - - - - - - - - - - - - - - - Special Notes and Comments POOL & SPA. FIREPIT #496AGAL. 5 LF OF 4' BLOCK WALL PER CITY STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. Fee summary Charged Paid Credited -----------------=--------- Due -------------------- Permit Fee Total; 306.00 .00 ---------- .00 306.00 ----------------------------------------------------------------------------- Application Number . . . . . 05-00000076 -.------------------------------------------------=-------------------------- Plan Check Total 148.35 .00 .00 148.35 Grand Total 454.35 .00 .00 454..35 Y i i i