05-3018 (RPL), ` l
P.O. BOX 1504'' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT., INSPECTIONS (760) 777-7153
BUILDING PERMIT
r Date: 7/19/05
Application Number: 0.5_ 0.OA03.018 Owner. _
Property Address: 53100 VIA VICENZE ALBERS, BILL
APN: - .772-520-004- - - 53-100 VIA VICENZE
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253 y
�. Property Zoning: LOW DENSITY RESIDENTIAL D
Application valuation: 20000 G Q
/ Contractor:. '
Applicant: Architect or Engi er: JUt 9'O'�D ALPINE -SERVICES
f O5 WCC: -STATE FUND
C/PYWC: 2290023236
01/01/06
-
C°CSLB:786324 10/31/06TAG70<
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- - - - - _ _ - _ - - - - - - - - - - - - - - - - - - - - - _ _ - - - - - - - - - - - - - - - - - - - - - - - - - _ _ - - - - - - - - - _ .- - - - - - - - - _ - - - - - - - _ - - -
LICENSED -CONTRACTOR'S DECLARATION ` WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under. provisions of Chapter 9.(commencing with _ `I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. '• _ I have and will maintain'a certificate of consent to self -insure for workers' compensation, as provided
License Class: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
te: I 6 Contract . r` I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
ry Code, for the performance of the work for which this permit is issued. My workers'- compensation
OWNER -BUILDER DECLARATION - - - insurance carrier and policy number are: -
hereby affirm under penalty of perjury that I am exempt -from the Contractor's State License Law for the Carrier C53 - Policy Number - -._-------------
following
------------following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any r "
construct, alter, improve,Aemolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, -
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State : - and agree that, if I should become subject to a workers' compensation provisions of Section t -
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I s fort ply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by /,� -
1 •
any applicant for a.permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: 0 Applicant:
(_ 1 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
c� Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered forsale. If, however, the building or improvement is sold within - SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). - - APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the -
7044, Business and Professions Code: The Contractors' State License Law does not apply town owner of conditions and restrictions set forth on this application. - -
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request'and for
pursuant to the Contractors' State License Law.). _ whose benefit work is performed under or pursuant to any permit issued as a result of this application, -
(_ 1 I am exempt under Sec. , B.&P.C. for this reason 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 being
performed under or fallowing issuance of this permit.
_ Date: Owner:. 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a constructionlending agency forthe performance of the - I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - city and c my ordinances and state laws relating to building constructs , and here orize representatives
.. of thi ounty to enter upon the above-mentioned property mspe o urp
Lender's Name: ate:6 7 Signature (Applicant or Agentl: "
Lender's Address:
LQPERMIT
Application Number
;:,. 05-00003018-
`. Permit . . . .
BLDG -POOL PERMIT
Additional desc .
Permit Fee• . . . .
207:00.. Plan Check
Fee .:
134.55
-_ Issue. Date . .
Valuation
. . .
20000
'Expiration Date
1/15/06
Qty Unit Charge
Per
Extension:
BASE FEE
45.00
18.00: 9.0000•
--------------------------------------------------------------
THOU BLDG 2, 001-25, 000
-------------
162' 00
Permit
MECH POOL .
Additional desc
_.
Permit Fee . ..
26.00.1 Plan Check
Fee
6.50
Issue Date
'Valuation
. .
0
Expiration Date__
1/15/06
Qty .. Unit Charge
Per
Extension
-
BASE FEE
15.00
11.00" 11.0000
EA MECH'FURNACE >100K
11:.00"
Permit _
ELEC POOL PERMIT -RES
Additional desc .,
Permit Fee
45.00 Plan"`Check
Fee :
11.25_
Issue Date.".
Valuation
0
Expiration:Date.'.
1/15/06
`Qty Unit Charge,
Per
.Extension
BASE FEE.
15.Op,
1.00 30:0000
-------------------------------------------------------------------
EA ELEC.PRIVATE SWIMMING:POOL
30.00
Permit
PLUMBING
'.Additional.desc .
Permit Fee
33.00 Plan Check
Fee
7.50
Issue Date
Valuation
0.
Expiration Date
1/15/06`
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
Special Notes and Comments
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
LQPERMIT
.'Application
Number 05-00003018
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Special Notes and Comments
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BE IN PLACE PRIOR TO PRE -PLASTER
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'INSPECTION. EQUIPMENT ENCLOSURE NOT
a
INCLUDED IN PERMIT
Fee summary Charged _
Paid 1Credited'
--- t-- - - - - - --
Due
----------
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----------- - - - - ------ - - - - -- - -
Permit Fee Total 311.00
- - -- - -
00 ',00
311.00
' �y•:
Plan Check Total 159.80
.0.0 .00
159.80
�,.
,
Grand Total 470.'80
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00,:'00
470.80
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120 c 0
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