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05-0057 (RPL)Ul 7WOF� G &SAFETY DEPARTMENT P.O.Box 1504 JAN `4 `2 2005 " . (760)•777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA,. CALIFORNIA 922'3 CITY 01M ON E QUESTS (760) 777-7153 P kANCE . DEPT. . BUILDING PERMIT Application Number C15-00400057 Date.' 1/06/05 Property.Address . . . 04'73-2_0—VIA CORDOVA APN : 6 4 3 -1`0-0 — 0-3-2 - - Application description POOL - •RESIDENTIAL Property Zoning . . . . . . LOW.DENSITY RESIDENTIAL Application valuation.: 1 17000- y Owner Contractor ._ p-. - - - - _ _ _ - - _ _ - 7-77-- BT DEVELOPMENT COMPANY" - -7 - - - _ _ _ - - - - - GATTUSO POOL,CORPORATION .30342 ESPERANZA 667 S. EUGENE ROAD RANCHO SANTA MARGARITA,,CA PALM SPRINGS, CA 92264 RCH SANTA MARGARITA, CA 92688 (760)327-75.92 (949)350-8647 WCC: HRH INS WC:: .16150742005 01/01/06 "CSLB: 672850 06/30/•05 CCC: C53 P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 I(�tl Application Number: Applicant: • BUILDING & SAFETY DEPARTMENT Applicant's Mailing Address: �« i �►.- "' VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 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 i m full force and effect. cense Class ^L�e No. (D� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempthe 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, i ove, demolish, or repair any structure, prior to its issuance, also requires the applicanffor 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 penaltyof not more than five hundred dollars ($500).): U 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 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 1 hereby affirm under penalty of perjury one of the following declarations: 1 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. _f!!4 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. Myworkers' compensation' nnce carrier and policy number are: .,.mer 0 sl V1✓� -"Policy Number _ I certify that, 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 forhwith comply with those provisiQnr---�, WARNING: FAILURE TO SECURE WORKERS' COMPENSATI N CO S UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS1 , 00), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, ANDA NEY'S FEES. — CONSTRUCTION LENDING AGENCY affirm I hereby arm 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 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 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 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 thi my to enter upon the above-mentioned property for inspection purposes. /Date d - ignature (Applicant or Agent): ----------------------------------------------------------------------------- Application Number 05-00000057 ----------------------------'------------------------------------------------ Permit BLDG POOL PERMIT- ERMIT-Additional Additionaldesc Permit Fee 180.00 Plan Check Fee 117.00 Issue Date . . . . Valuation . . . . 17000 Qty Unit Charge Per Extension BASE FEE 45.00 15.00 9.0000 THOU BLDG 2,001=25,000 135.00 Permit . . . . MECH POOL.; Additional desc Permit Fee . . 24.00 Plan Check Fee 6.00 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension j; 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 EAPLB 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 ONLY. ALARMS/BARRIERS. SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged Paid Credited Due Permit Fee Total 282.00 .00 .00 2'82.00 Plan Check Total 142.50 .00 .00 142.50 Grand Total 424.50 .00 .00 424.50