04-3344 (RPL)BUILDING & SAFETY DEP ENT
V.O. Box 1504 (760) 777-7012
c� _0278-495_Cr-,A�-,LLE TAMPICO FAX (760) 7.77-7011
D�� LPA QUINTIACALIFORNIA 92253 INSPECTION REQUESTS (760) -777-7153
°�, U BUILDING PERMIT
iu,l 0 3 2004
Appli_c_at.ion Number 04-00003344 Date 4/08/04
s
8054"5~VIA .TALAVERA
P roper`t�y��Addre s
APN: 772-250-999-142 -30357 -
Application description(_ POOL s RESIDENTIAL
Application valuation . 18000
Owner Contractor
TOLL CA V CALIFORNIA POOLS & SPAS
C/O KEVIN D DUERMIT P.O. BOX 1280•
8901 E MOUNTAIN VIEW 200 COACHELLA CA 92236
SCOTTSDALE AZ 85258- .(760). 398-9222
WCC: STATE FUND
WC: 04600061168 01/01/05
CSLB: 656128, 10/31/04
CCC: C8 -C27, -C29-053
Permit . . MECH`POOL
Additional desc
Permit Fee 24.00 Plan Check Fee 6.00
Issue Date Valuation . . . . 0
Qty Unit Charge Per.. Extension
BASE FEE 15.00
1.00 9.0000 EA, MECH FURNANCE.<=100K 9.00
----------------------------------------------------------------------------
Permit BLDG POOL' PERMIT ".
Additional. desc
Permit Fee 189.00 Plan Check Pee 122.85
Issue Date . . . .. Valuation 18000
Qty Unit Charge Per Extension
BASE FEE 45:00
16.00 9.0000 THOU BLDG 2,001-25,000 144.00
Permit . . ELEC POOL PERMIT -RES
Additional desc
Permit Fee 45.00 Plan Check Fee 11.25
Issue Date . . :Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA , ELEC PRIVATE SWIMMING POOL 30.00
P.O. Box 1504, • VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Date:
Applicant:
Applicant's Mailing Address:
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 (commencing with Section 7000) of Division 3 of the Business and Professionals
,....Code; and my License i in fu �.fprce and effect.
License_Class) — ` License No. f
,C
Date 1 2� Cone
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 for a 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.).
U 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. , B.& P.C. for this reason
WORKERS' COMPENSATION DECLARATION
I 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 a d will main in workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ssu d. My coo es' comp nsation insurance carrier and policy n ber are:
Carrier- (`Policy Number �J
I certify that, in t performance of the work for which this permit id i sued, I shall nst employ any person in any manner so as to become subject to the workers'
compensation laws of Califomia, and agree that, if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisio
Date r—Applicant
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
Lender's 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 Ouinta, 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 en upon the above-mentioned property for inspection purposes.
Date 'v� rSignature (Applicant or Agent)'
f~
Page 2
.Application Number. ." 04-00003344,
Date 4/08/04
Permit PLUMBING
Additional desc .
Permit Fee` - 33.00,`Plan Check Fee
8.25 .
Issue Date Valuation
0
Qty Uhit 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/R"EP
.3.00.
" 1•..00 3.0000 .EA PLB GAS PIPE 1-4 OUTLETS
3.00.
Special Notes and Comments
POOL & SPA." BBQ ANSI Z21-58=1995.
ALARMS BARRIERS SHALL BE IN PLACE PRIOR
-" TO PREPLASTER INSPECTION.
Fee summary" Charged Paid Credited
Due
Permit Fee Total 291.00 .00. .00
291.00
Plan Check Total ."148:35 :00 .00.
148.35
Grand Total 439.35 00 .00
439.3.5