04-3703 (RPL)°F �wQur«rw
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)777-7153
BUILDING PERMIT
Application Number 04-000370 Date 4/26/0+
Property'Address . . 80010 VIA VALEROSA
APN: 772-250=999-1 -30357 -
Application description,. POOL --RESIDENTIAL
Property Zoning-. LOW DENSITY RESIDENTIAL
Application valuation...'5000
Owner Contractor
--=-------------------- -------------------- ---
TOLL CA V CALIFORNIA POOLS & SPAS
C/O KEVIN D DUERMIT P.O. BOX 1280
8901 E MOUNTAIN VIEW 2.00 COACHELLA'. CA 92236
SCOTTSDALE AZ 85258 (760) 398-=9222`
.WCC: STATE FUND
rWC: 046000.61168_ 01/01/05
CSLB: 656128. 10-/31/04
CCC: C8 -C2'7 -C29-053
Permit . . . BLDG POOL PERMIT
Additional desc
Permit.Fee 72.00 Plan Check Fee 46.80
Issue Date Valuation 5000
Qty, Unit Charge Per Extension
BASE - "FEE 45.00
3.00 9.0000 THOU BLDG 2,001-25,000 27.00
Special Notes and -Comments
KI VA ONLY.'.
Fee summary Charged Paid Credited Due
Permit Fee Total 72:00 .00 .00.1 72.00
Plan Check Total 46.80 .00. .00 46.80
Grand Total 118.80 .00 .00 118.80
APR 28- 2044 M
CF "llyr,.:�aszA
P.O. BOX 1504 a ��G�w
VOICE (760) 777-7012
78-495 CALLE TAld/1C0 FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 440
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: ��%— .��� Date:
i, :ja��It
Applicant's Malting Address:
Architect or Engineer.
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty a perjury that 1 am licensed under provisions a Chapbr 9 (opommenmV with Setion 7000) a Division 3 a to Business and Probssiorals
Code. and may License is in fylle and effect . G/Z d
Lbenae Cuss ( j
Date • -a 7-6yG,,,,;,�ar No
'l-.6
I hereby etram under penalty a perjury that I am O WNER$tmDER DECLARATION
from W Contractors' Stale Lioense Law for tier fallowing reason (Sec. 7031.5. Business and Probssfons Code: Any
city or county that a permit b construct, alter. improve. demoistry or repair MY shmrcone, PrW b Its issuance. also requires the applicant IN the t to be a signed
stalemerM fist he or she k licensed pursuant b fie provisions a the Cw*wbm' State License Law (Chapter 9 (Comm000
(Commencing with Section 7) a Division 3 a are Business
and Protessioru Code) or that he or she Is exempt aneetrom and the bass ter ane alleged ererrptie► Any violation a Section 7031.5 by any aP15 l ter a permit subjects
the applicant boo clivi penalty of not more l an ave hundred doaars (5500).)
U 1. as owner of the property. or my employees with wages as their sob compensation, w1 do the work and the structure is not Intended or oflered for sale (Sec- 7044;
Business and Pmaesswm Code: The Cambsctors' Stab License Law does not apply b an owner of property who builds or improves thereorn. and who does the work
himself or herself or through his or her own employees, provided that the iMP" emnerts are not Intended or oft for sale. K, however, the b&M*V or irprovertment is
sold with one year a o0mpletion, the owner -builder will have the burden a proving that he or she did not im
build or improve ter a ).r the purpose sale.
U 1, as owner Of the properly. am exclusively Coneraafing with", P t A contracbre b construct the project (Sec. 7044. Business and Piaessions Code: The Conaaclors•
State License Law does not appy b an owner of properly who builds 0r improves thereon, and who contracts for the projects with a corwsctcx s) licensed purswnt b
the Contactors' Stab License Law.).
U I am exempt under sec . B.& P.C. for this reason
Date Owner
WARS' COMPENSATION DECLARATION
1 hereby affirm under
PAY of ply one Of the biowirq declarations:
_ I have and will maintain a Certificate of consent b sell.Insure for workers' oorpensatian, as provided for by Section 3700 of the Labor Code, for the pefomnanoe
a the work for Midi this pe . Is issued.
_ I have
,ad �wil maintain workers' compensation it musncs. as required by Section 3700 a the Labor Code. for the performance a the work for which the per" is
comfier �7 /� "'> q erS .QOrmPensabonP umber rand poi err are:
Ce" that, in the Pwbffn wi of the work ter whmidn this pe .io is issued. I not enpby any person in any manner so as to beconme subject b the workers!
oompemss- laws of California. . agree oat III should become subject b the workers' tion
�r„ft any with those compensation provisions a section 5700 a the Labor Godo.1 shat
Date % " 27'x` Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SFALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE HUNDRED C E. INTER DOLLARS t:100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE. RdTEREST. AND ATTORNEYS FEES. .
I hereby affirm index CONSTRUCTION LENDING AGENCY
peaky a De+leRy that ttnere is a Construction bn*V agency lor the performance a the work for which this permit is issued (Sec. 3097. Civ. C.).
Lenders Name
Lenders Address
IMPORTANT Application Is hereby made to the Oirecbr a APPLICANT ACKNOWLEDGEMENT
1. Each Person upon whnose behalf this BWk%% and Safely for a pomft subject b the conditions and restrictions set forth on this application.
Issued as •resat a this a mon is made. each person at wtmose request and for whose benefit work is performed under or pursuant b any permit
arm. sa and application, the owner. and the applicant, each We" b. and shall. defend. indemnify and hold harmless the City a La Ousts, Its
2. Any peril issued as rMloyees for a as «aNssion related to the work being performed under or following; issuance a 1Ns pemdl
cessation a week as a result d application becomes mud and void If work is not commenced within 160 days from date a issuance a such permit, or
1 certify that I have read this a and state that the � � a�� D� b ce l'
consf+uctiom. and hereby authorize roepresentatives a this above information is mzrrect 1 agree io comply with all dry and county ordinances and stale favvc relating b building
county b upon the above-mentioned property for inspection purposes.
Date 2� Signature (Applicant or Apert):