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04-3570 (RPL)2C 04. 64P +; BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760) 777-7012 CIOF9� 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORKIA 92253 INSPECTION REQUESTS (760)777-7153 BUILDING PERMIT Application Number : 04=00003570 _j Date 4/19/04 Property Address. 49583 VIA CONQUISTADOR APN: 64--210-067-8 -29283 - Application description.. POOL - RESIDENTIAL Property Zoning . . . . . . .LOW DENSITY RESIDENTIAL Application valuation 25.500 Owner Contractor BRANDT JEFF TOPMAN BUILDERS 49583 VIA CONQUISTADOR P.O. BOX 10202 LA QUINTA CA 92253 PALM DESERT CA 92255 (760). 772-3296 WCC: AU INS SRVC 005.00019402 01/01/05. CSLB;:. 455121 11./30/05 CCC.:... B -C29.. Permit MECH `POOL Additional des c.. -Permit Fee 33:00 Plan Check Fee 8.25 Issue Date. . . Valuation 0 Qty Unit - Charge Per.. Extension BASE .FEE `. 15.00 2.00 9.0000 EA • MECH FURNANCE <=100K 18.0.0 17 Permit BLDG POOL PERMIT Additibna'l, desc Permit Fee . . . .258.50 Plan Check Fee 168.03 Issue Date Valuation. ' 25500 Qty Unit Charge. Per. Extension BASE FEE 252 ..00* 1.00 •6.5000 THOU BLDG 25,001-50,000 6.50 Permit ELEC,.',POQL,PERMIT-RES Additional desc Permit Fee 45.00 Plan Check Fee 11.25 Issue. Dat -e Valuation . . . 0 :Qty'... Unit -Change Per Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 P.O. B6X 1504/� a ' V`/ VOICE (760) 777-7012 ' 78-495 CALIe TAM►ICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 ot, 4 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number. Applicant: Applicant's Mailing Address: 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 (Camroncig with section 7000) of Division 3 of to Business and' PwIessionafs Code. and my We kin furl roe and effect �Licenee Class== "S12A . 1 hereby afiurn under OWNER•8UILDER DECLARATION Penalty of perjury am from the contractors' State License Low for the bpowirg reason (Sec, 7031.5. Business and Professions Code: Any city or county that requires a permit b improve. derarhsfh, or repair any stuctue, prior b its issuance. also requires the applicant for the permit b fib a signed aind Pmfe Chat ha or she r W he o Phtt 10 asuarCha provisions of the Cw*acbrs' Stab mm thLicense Law (Chapter 9 (eaenCing with Section 7000) or Division 3 of the Business appa Code) «C «she Is exempt meho an n d the basis for a alleged exemption. My violation o(Section 7031. Che licant b 5 by any applicant for a pemiil subjects th I, as owner a the Pah of not more than rive hundred dollars ($5o0).) property. or my enowyees with wages as their sole eompenhsatim wig do Che work, and the structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractors! Stab license Law does not apply b an owner of Property who builds or improves thereon, and wtw does the work hirnseff or herself or through this or her own employees, Provided that the improvements are not intended or offered for sale. it. (however. the building or improvement is sold within one year of completion, the owner -Milder wig have the burden of proving Wit 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 conte to construct the pact (Sec, 7044. Business and Professions Code: The Contractors' State License Law does not appy to an owner of property who builds or improves thereon.' and who contracts for the projects with a contractors) licensed pursuant b the CWftCiDrs' State License Law.). U I am exempt under Sec. . 8.3 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the fotlowintg declarations: _ I have and wB maintain a certificate of consent to setinsure for workers' compensation. as provided for by Section 3700 of the Labor Code. for the Performance of the work for which tis per.. Is issued. _ 1 have and will maintain worker:' compensation insurance, as fired by Section 3700 or the Labor Code, for the performance of the work for which this issued. My oompensati0n Yauanhce carrier and policy n r k GCarrier V . L Pty Number =I- I itmaf, in the nhceof the work for witch this Permit is issued. I shall W employ any person in any manner so its to become shrbjeCt to the workers' compensation laws of trot, if 1 should become subjed b the workers' con fontwritm.�Y with those California,�. n compensation Provisions of Section 3700 0l the Labor (',oda. l shat WARNING: FAILURE TO SECURE WORKkW ION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES LIP TO ONE KINDRED THOU (1100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTE D ATTORNEYS FEES. I hereby affirm m under penalty of perjury that there is** emu' CONSTRUCTION CONSTRUCTION LENDING AGENCY Ding agency for the pedwrnance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lenders Name Lenders Address IMPORTANTAPPLICANT ACKNOWLEDGEMENT Application is hereby made b the Director of Building and Safety for a Permit subject b to cond'Aions and restrictions set font on tis appicaCwL 1. Each person upon whose behalf tis application Is made. each person at whose request and for whose benefit work is pedor med under or pursuant b a Issued a result of this application, the owner. and the ffnit appnc�snt, each agrees b. and shad. defend. indemnify and hold harmless the City of La Otinta i s� agents and employees for any act or omission related to the work being performed under or following issuance of this permit 2 Any Peril issued asa result of this application becomes n cessation of work for 1ull and void if work is not Conanenced within 180 days from date of issuance of such pemhlt or 180 days will subject perm b cance0ason. I certify that 1 have read this application and state that the above Infon Is correct 1 agree ifor comply with city and county ordinances and state laws relating b building construction. and hereby authorize representatives of this county b above-mentioned property for inspection purposes. . Date Signature (Applicant orAgent Page J 2 Application Number 04-00003570 Date 4/19./04 Permit PLUMBING Additional'dese Permit Fee - 33.00 Plan Check Fee 8.25 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE " 15.06 it -2.00. 6.0.000 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 174 OUTLETS 3:00 Special 'Notes and Comments, ------------ POOL & SPA. BBQ DBQ-30, FIREPIT ANSI 21-5871998.. ALARMS BARRIERS SHALL BE IN I PLACE PRIOR TO PREPLASTER INSTPECTION. Fee summary Charged Paid Credited Due Permit Fee Total ;369,50 .00 .00: 369.50 Plan Check Total _ 195.78 .00 .00' 195.78 Grand Total. 565..28 .00 00 565.28 '1 r