04-5854 (RPL)BUILDING & SAFETY DEPARTMENT
c _P.O. Box 1504 (760)•777-70.12
�-
- - 78-495`CAr:LE TAMPIC
O FAX (760) 777-7011
A Q[+JI�NTA, CALIFORNIA 92253 INSPECTION' REQUESTS (760) 777-7153
AUG 11 2004 BUILDING PERMIT
(TTY QUINTrA _-
App IF lca .ion-'2rNumbe.r �04,-0000-58-54_-,-1 Date 8%05/04
Property Addfess 80-100 VIA VALEROSA
APN: 772-250-999-10 -30357 -
Application".descript,ion POOL - RESIDENTIAL
Property Zoning . . . LOW DENSITY RESIDENTIAL
. Application valuation 3000
Owner Contractor
TOLL CA V CALIFORNIA POOLS & SPAS
C/O'KEVIN D DUERMIT .I P.O BOX 1280
-8901 E MOUNTAIN VIEW'200. COACHELLA CA 92236
SCOTTSDALE AZ. 85258 (760) 39879222
WCC: STATE FUND'
WC: 0.4600061168., 01/01/05.
CSLB: 656128 10/31./04
CCC:. C8 -=-C29-053
Permit ELEC-POOL PERMIT -RES'
Additional desc..
Permit Fee .45.00 Plan Check Fee 11.25
Issue Date ..;Valuation 0
_ Qty Unit Charge Per. _.
" r :' Extension .
J BASE, .FEE -15.00
1.:00 30.0000 EA,' ELEC PRIVATE SWIMMING POOL 30.00
Permit . . PLUMBING
Additional desc
Permit Fee F21.00 Plan Check Fee 5:25
Issue Date Valuation `. 0
Qty Unit Charge Per Extensiony
..BASE FEE 15.00
1.00. 6_0000 EAT PLB FIXTURE 6.00
Special Notes and Comments
WATER.FEATURE.
:Fee summary,- Charged Paid Credited Due
Permit;'Fee , Total 66.. 00 .. 00 .. 00 66-.00
Plan Check Total .16.50 .00 .00 16.50
P.O. BOX 1504
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
La QutNTa, CALIFORNIA 92253 4.4 a
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0 Date',
Applicant:.
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Ad ss
Lic. No.:
BUILDING PERMIT DECLARATIONS
LIC NSEO CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under pro i ' of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Lice a is in 11 force and effect. S
License Class — Lice
Date ConUactor 41
L TOWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that am exempt from ontre
city or County that requires a permit to construct, alter, improvctors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
e, 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 for a permit subjects
the applicant to $ 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 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. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
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.
_ I have and will maintain porkers' compensation insurance, as required by Sectio g 3700 of the Labor Code, for the performance of the work for which this permit is
iss d. yyvorkers' mpensation insurance carrier ai�d ppolicy nu be ire /
Cam: Policy Number ®�-/ 7 7 /„ %/
_I certify that, in the performance of the work for
compensation laws of California, and agree 1
forthwith comply with those pr sions.
Date /// Applicant �Zf
WARNING: FAILURE TO SECURE WORI(ERS' COMP649A
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
SECTION 3706 OF THE LABOR CODE, INTEREST, AND AT
is i ued, I shall not employ any person in any manner so as to become subject to the workers'
,or subject to the workers'. compensation provisions of Section 3700 of the Labor Code, I shall
GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
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
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 perfomned 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 Quinta, 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 ' o menced within 180 days from date of issuance of such permit or
cessation of work for 180 days will subject permit to cancellation. c
certify that I have read this application and state that the above information is correct
construction, and hereby authorize representatives of this county t nter upon the bo gree ant edpropertyty for nall s and county ordinances and state laws relating to building
inspection purposes.
Daie_&// //O Signature (Applicant or Agent):
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