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04-6624 (RPL)do �wQ�rw BUILDING & SAFETY DEPARTMENT P.O. -Box 1504(760)777-7012 �FV 'V_0 78-495 CALLS TAMPICO 1 FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 717-7153 BUILDING PERMIT Application Number 04-00006624 Daae 10/05/04 Property Address ... . . 80550 VIA TALAVERA APN: 772-250-999-127 -30357 - Application description . POOL - RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL Application valuation . . . . 30000 Owner Contractor - ------ -------------- - --- --- - - - - - - DEAN RATHBUN WESTERN POOLS 201 SANDPOINTE 4230 P.O. BOX 1047 8901 E MOUNTAIN VIEW 200 a.INDIO CA 92201 SANTA.ANA CA 92707 (760)`200-1110 "WCC": STATE FUND WC: 12709962004 02/01/05 CSLB: 348768 12/31/05 .CCC: B-053 Permit . . . . . BLDG POOL PERMIT . Additional desc Permit Fee 284.50 Plan Check Fee 184.93 Issue Date 'Valuation _ 30000 Qty Unit Charge Per Extension BASE FEE 252.00 5.00 6.5000 THOU 'BLDG 25,:001-50-,`000 -, 32.50 Permit ,. MECH POOL Additional desc`. Permit Fee 24.00 Plan Check Fee .. 6.00 Issue Date Valuation 0 Qty Unit:Charge Per Extension BASE F,EE 15.-00 1.00 9.0000 EA MECH FURNACE <=1,00K 9.00 Permit ELE£ POOL PERMIT -RES Additional desc Permit Fee 451.0.0Plan Check Fee-. 11.25 Issue Date Valuation 0 Qty Unit Charge. Per Extension BASE FEE 15.00' P.O. BOX 1504/i • w VOICE (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011,G`�� LA QUINTA, CALIFORNIA 92253 4 4 a INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0q- (o (o ,�N Applicant: I Architect or Engineer: Date: Applicant's Mailing Address: 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 Lice niGn�yrce and effect. V �� -,cense Class 33 -,cense No. Date ontractor W-05't'lem F2��l S OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the 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, improve, 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 fora permit subjects the applicant to a 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.). (_) 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 0, WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: f 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 workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is S��&-Wy wort ers' compensation in�urance.carrier and policy number are: �rrier 1' incl ,Po-licy Number _(2704q Loc—t4 _ 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 forthwith comply with those provisions. ate �b� Q I d` -i <p'plicant _ WeST— n V&> WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 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, 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 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 this county to enter upon the above-mentioned property for inspection purposes. Date 1 O 8 OL4 -- Signature (Applicant or Agent): 11;11,1zz&4V Page 2 Application Number' 04-00006624 Date 10/05/04 Qty Unit Charge Per Extension 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 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. ALARMS/BARRIERS SHALL BE IN PLACE AT,PRE-PLASTER INSP,ECTION., EQUIPMENT ENCLOSURE NOT INCLUDED. Fee summary Charged Paid Credited Due Permit Fee total 386.50' .00 .00 386.50 Plan Check Total 210.43 00 .00 210.43 Grand Total 596.93 .00 .00 596.93 J r � •" a m .: r ,O0LS �1sm Darby Rd. Berinudibii a; CA 92203 Ph.:?80-a0Q-1110 Fu 780 -?.00-4777 f 8,4g< �L a. !t r o cAn �ac�2��2sust � , A RE -INSPECTION FEE OF$30 WILL BE CHARGEDIF THE APPROVED PLANS AND JOBARD ARE NOT ON THE SITE. FOR A SCHEDULED INSPECTION. NO EXCEPTIONS! W'" L Poo I Ll v; 1�� . f W'" L Poo I Ll v; 1��