04-5087 (RPL)• c'3 ry •
BUILDING & SAFETY DEPARTMENT
c ^�v P.O. BOX .1504 (760).777-7012
OFTi9 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA.92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
A plication Number-,. 04=00005087 Date 6/22/04
'-.'Property Address --. - . ... 8-0580—VIA-TALAVERA
APN: 772-250-999-130 -30357 -
Application description POOL - RESIDENTIAL
Property Zoning.. LOW DENSITY RESIDENTIAL
..Application -valuation. 20000
Owner Contractor
TOLL CA V CALIFORNIA POOLS & SPAS
C/O.KEVIN D DUERMIT P.0'. BOX 1280.
:.'8'9 0 1 :E MOUNTAIN. VIEW '200° COACHELLA :. CA 922.36.:
SC.OTTSDALE AZ 85258' (760) 398-9222.
;WCC: STATE. FUND..
�•..WCi. 046000611.68 01/.01/.05
CSLB: 656128 ..: 10/31/04
:CCC: 't& C2.7
-C29-053.
----------------------------------------------- - - - f_
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. 0.000 EA MECH. FURNACE.. <=100K: .9-.-6o
Permit. BLDG POOL PERMIT
Additional desc .
Permit Fee 207.00 Plan Check Fee 134.55
Issue Date valuation.20.000
Qty Unit Charge Per Extension
BASE FEE
18.00 .9.:0000 THOU BLDG 2,001-25,000
--------------------------------------------------------------
Permit .. . . . ELEC POOL PERMIT=RES
Additional desc
Permit Fee. 45 . 00. , . Plan Chek��
Issue 'Date' . Valuation\
Qty:. Unit Charge Per
BASE FEE
0
0
5
0
in
0
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777=7011
LA QuINrA, CALIFORNIA 92253 INSPECTIONS (760) 7774153
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
1 hereby affirm under penalty of perjury that I am licensed under p ns of Chapter 9 (commendng with Seddon 7000) of Division 3 of the Business and.Professtonals
Code, and my, Uyen�1 ,S,S m �l1 and effect.
License Classl�.S (� /_ Licen No.
Date Z Z LD Y Contractor
ER -BUILDER DECLARATION
I hereby affirm under penalty of perjury tha1 am exempt from the Contractor:' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, after, 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 ($5W).): 1
U 1, 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 projed (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 1 am exempt under Sec. , B.B. P.C. for this reason
Date Owner
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 self4nsure 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.
1 have and will maintain workers' compensation Insurance, as required by -Section 3700 of the Labor Code, for the perfornance of the work for which this permit is
mprerkers' com ensation insurancecarrier n licy�yrr
Carrier 5��/�1./��-C� . /� 71 Pol.tor
C�CJr] C� ri
=1 certify that iri the performance ofthe work for i this mrit Is issued, I shall not employ any person in any manner sit as to become subject to the workers'
compensation laws of California, and agree t H I sh Id become,subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date..6 Z /[ Applicant
_ZJ,,f1
WARNING: FAILURE TO SECURE WO9ERS' Ctlptlelf7S ON OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL. FINES UP TO ONE HUNDRED THOUSAND DOLLARS 000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 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 (Seo. 3097, Civ. C.).
Lender's Name
Lenders Address
.. APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a perm 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 ag s 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 Ing ed under or following issuance of this pernft.
2. Any permit issued as a result of this application becomes null and void H rk LS of mmenced 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 1 have read this application and state that the above information is I a ree comply with all city and county ordinances and state laws relating to building
construction, and here authorize representatives of this county t ter upon bo tinned property for inspection purposes.
Date Signature (Applicant or Agent):
Page 2
Applicatibh`Number,: . . . 04-00005087
Date 6/2.2/0.4
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
15.0'0
2.00 6.0000 EA PLS' 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 W/5LF 51;GARDEN BLOCK WALL.
Fee summary Charged Paid Credited
Due
Permit Fee Total 309.00 .00 .00
309.0.0
Plan Check Total 160.05 :00 .00
160.05
Grand Total 469.05 .00 '.00
469.05