04-7022 (RPL)BUILDING & SAFETY DEPARTMENT
.1504 (760).777-70.1,2 . .
F 78-495 1:ALLE TAMPICO 'FAX (760) 77.7-7011
U LA QUINA; CAL.IFORRIA .92253 INSPECTION REQUESTS (760) 777-7153
" NOV b �3 2Q0� .
_ ... BUILDING. PERMIT
CkultiTA
of
pA�IOE Qo Number -_.. .
04-00007022._ Date 11/05/04-
Property .Address. -. '`: ` 80585 VIA TALAVERA.
APN: 7727250-.999-139 -30357 -
. Application description POOL RESIDENTIAL
Property..Zoning LOW: DENSITY RESIDENTIAL
Application valuation -18000 .
Owner..Contractor
TOLL CA V C.; CALIFORNIA POOLS &,SPAS
C/O KEVIN.D DUERMIT P.O: BOX .1280
8.901 -E 'MOUNTAIN VIEW. 200 COACHELLA .. CA .92236
SCOTTSDALE AZ 852'5'8:. .(760) 398-922'2'.
WCC: STATE FUND
WC c. 04600.061168 01/01/05
CSLB::': 656128 : 10/31/06:
CCC: C.8 -C27 -:C29-053
-------------------
Permit / MECH POOL.
Additional desc
Permit.. Fee 24.•0.0 Plan Check Fee 6•.00
Issue Date Valuation 0.•a:o..
Qty Unit Charge Per 'Extension
BASE FEE' ... :: 15. 0.0'
1.0.0 9.0000 ;EA- MECH FURNACE :<=100K7_777-
9.00
-----------------------
Permit BLDG POOL PERMIT
Additional.desc
Permit .Fee 189.00 Plan Check Fee 122.85
Issue.Date Valuation. 1.8000
Qty. Unit 'Charge Per Extension
...BASE FEE'. 45:0'0
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'
1.00• 30.0000 EA ELEC PRIVATE SWIMMING POOL.." 30.00
Permit PLUMBING
Additional desc
P.O. BOX 1504'
79-495 CALLS TAMPICO
LA QUiNTA, CALIFORNIA 92253
Application Number:
Applicant:
Applicant's Mailing Address:
BUILDING & SAFETY DEPARTMENT
VOICE (7ti6) 7.77-7012
FAX (760) 777-7011
INSPECTIONS (760;) 777-.7153-
Date:
77-7153
Date: .IF 0
Architect or Engineer:
Architect or En e s dress:
Uc. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (Conmendng wkh Section 7000) of Division 3 of the Business and PrOfesslonals
Code, and my Ll enssu�,,is in full force and effect.. License
�a Q
0
License Class Com. 53 �;;e No to
Data -&l 6 Contractor `
47
r�
I hereby.affirm under penalty of perjury that 1 am a OWNER' State R DECLARATION
exempt from the Contractors' State License Law for ft following reason (Sec. 7031.5. Business and Professions Code: Any
city or county that requires a pemdt to construct, alter, Improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for the. permitto 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 ntC ) or.Orat 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
PP penalty of not more than five hundred dollars ($500).),
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 (Seo. 7044,
Business and Professions Code. The Contractors' State License Law does not appy 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 tmprovements.am not intended or offered for age. IL however, the building or immprovembnt 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.).
ely
U 1. as owner of the property, am exdushrcontracting with licensed contractors to construct the project (Sea 7044, Business and Professions Code: The Contractors' .
State License Law doss not appy 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 Sea _ B.S PSC. for this reason_
Date Owner._...
WORKERS' COMPENSATION DECLARATION .
hereby affirm under penalty of perjury one of the following declarations:•
_ 1 have and.will maintain a certificate of consent to selfansiurefor workers' compensation, as'provided for by Section 3700 -of the Labor Code, forthe performance
of the work for which this permit is Issued..
I hhave and w(II maintain workers' compensation Insurance, as required DySectior► 3700 of the Labor Code. for the performance of the work for which this permit is
Mywror�grs•Com enation.tihsurancecarrierandrare
Canter, _S-f,i?P Policy NumberD5�(o�/a/)//
_'1. certify that, to the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the wokers'
compensation laws of California, and agree that, it.l should become subject to the wokere' compensation provisions of section 3700 of the Labor Code,1 shall
forthwith comply with those Provisions.
Date e9 O
Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), f N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 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 (Sea 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.
I. Each person upon whose behalf this application is made, each Penn 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, nd shall, defend, Indemnify and hold harmless the City of La Oulnta, its
officers, agents and employees for any act or omission related to thevrork being under or following issUanoe of this permit
2 . Any permit Issued as a result of this application becomes null and void it work cad within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject penult to cancellation.
1 Certify that 1 have read this application and state that the above Infomadamis I Comply with ail city and county ordinances and state laws.relating to building
construction. and hereby authorize representatives of this county to uponthe property for inspection purposes.
tate l ! v O Signature (Applicant or Agent):
Page 2
Application Number . . . . 04-00007022 Date. 11/05/04
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
Permit . . WALL/FENCE PERMIT-
Additional desc
Permit Fee 15.00 Plan Check Fee .00
Issue Date Valuation 80
Qty Unit Charge `Per Extension
BASE FEE _ 15.00
Special Notes.and Comments
POOL & SPA. BBQ ANSI Z21-58-1995 5 FL 4'
BLOCK WALL CITY STND.
FIREPIT 496AGAL..ALARMS/BARRIERS SHALL
BE IN PLACE PRIOR TO PREPLASTER
INSPECTION._
Fee summary Charged Paid' Credited Due
-=--------------- ----------- --------- ---------- ----- --
Permit Fee Total 306.00 .00 .00 306.00
Plan.Check Total 148.35 .00 .00 148.35
Grand Total 454.35_ 00 00_ 454.35