04-6850 (RPL)r
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BUILDING .& SAFETY DEPAR:TMERT
w4 P.O., Box 1504 (76.0).777-70.12
OFT'9` 78-495 CALLE TAMP.ICO FAX (760) 777-7011
LA QUINTA, CAL,It:ORNIA .922.53 INSPECTION REQUESTS (760) 777-7153
BUILDING. PERMIT
Application Number 04-00006850 _ Date 10/20/04
Propert:y..Address . 8.0.605_ VIA TALAVERA
APN: 772-2'50-999-.137 -30357
Application description:.. POOL.-.RESIDENTIAL
Property.Zoning LOW DENSITY RESIDENTIAL
Application valuation. 18000
Owner. Contractor .
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-TOLL-CA V CALIFORNIA POOLS & SPAS _
C/O KEVIN D DUERMIT P.O. BOX:_1280
'8901-E MOUNTAIN VIEW 2001... COACHELLA CA;92236-
SCOTTSDALE AZ 85.25.8.. ..` (76.0) -398-9222-
WCC STATE,- FUND ..
WC 0460:006116.8 01/01/.05.
CSLB.; .65612.8. 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 0:1
Qty Unit- Change.. ..Per Extension
-
BASE. FEE 15.0.0
1.00 9..0000..EA MECH FURNACE <=1.0.OK 9.00
Permit BLDG POOL PERMIT
Additional. desc.
Permit.Fee. 189.00 Plan Check -'Fee: 122.85
Issue Date Valuratiofl �.. 1800.0
Qty Unit Charge Per (Extension
BASE FEE OCT. 2 2 20121 �' :. 45-.00
16.00 9.0000 THOU BLDG 2,001-25,000, 144.00
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-Permit . . . . : . ELEC POOL PERMIT-RES P1��Ac�V-Z UzPT. Additional desc..
Permit Fee •45.00 Plan Check Fee 1.1-.25
Issue Date Valuation 0'.
Qty: Unit Charge Per Extension
BASE. FEE 15. 00
1.00- 30.0000 EA ELEC PRIVATE SWIMMING'POOL 30:0.0
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Permit . . . . . . PLUMBING
Additional desc '
P.O. BOX 1504
'78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number,
Applicant:
Applicant's Mailing Address:
BUILDING do SAFE'L'Y DEPARTMENT
VOICE (7 66) 777-7012
:.FAX (760) .777-7011
INSPECTION$ (760) 777-7153
Date: .
Architect or Engineer
.Architect or Engineer's Addr s•
V/
Uc. No.:
BUILDING PERMIT DECLARATIONS
1 hereby affirm under LICENSED CONTRACTOR'S DECLARATION
Code. De tY of pact &that 1 am icerised under provNfon: of Cts Pier 9 (Wmmndng wt(h Secdon 7000) of DMsion 3 of Ihe'Businesa and prthsswws
License Class lain tuA broe and.effoct.. •
Uoense No.
:.Days /1qb/ 6
Contractor
usiness end Professions Code: Any
the toRvwkq reason (See.
I Hereby affirm under penalty of perjtxy that 1 am exempt from the ' OWNER -BUILDER DECLARATION
Lawlor 7031 6.B
city or county that requlros a.Pem�mit b Construct atter, kMrotre. demolish, or.ropak State any License prior pto its Issuance. also requires the spoicant for the. permit to file a signed
staUmwand Professions that h a she Is licensed pursuant to the provisions of the Contrgciore State License Law (Chapter 9 (ownywrockhg with Secfieon TM) of Division 3 of toe Business
�oqe) or.that he or she.k exempt therofiom and the bask for the alleged exemptipt Any violation of section to any appGcard for a permit subjects
ttapplicant to a eNi. penatty of not more than five hundred dollars ($SW0 t
U
Las owner of the property.'or my employees with wages as thele sole Mnpw tion, wti do tta work, aM tie *ucium k root intended or offered for sale (Sec. 7044,
Business and Professions Code: The Coittradors' State License Law does not apply to an owroer of property who bWds or improves thereon, and who does toe work
himseU or herself or ttrough his or her own employees, provided that the knpmvW Wofs.ere not intended or offered for sats. k however. the buddirog or knprovermbnt k '
sold witiiin one year of Comptetlon, the owrw4xAder wW have, the burden of
• (,) L. as owner of the t�>v t,at he a etre did not bold or krprove for the Purpose at sate.)
�� not apdusFrey owner property who contractor ov construct the Dro1� (� 7044. Business 9nd Professions Code: The Coatractore
State license s' S does not appy b.an owner of property wino builds or improves t>ereort. and who oorttraats for the projects with a contractor(s) kensed pursuant to
the Contractus' State License Law.). .
(� I am exempt under Sea B.3 PA- for this reason
Date Ovvner�• _ .ti
1 hereby affirm COMPENSATION DECtDECLARATION.affirmunder penally of perjury pros of toe following declarations
—1have and mill maintain a certificate of consent to seN•insure for workers' conpensagon, as provided forty Section 3700 of tie Labor Code, bathe perfomiartoe ,
of the work for which this Permit is issued..
"have and win maintain workers' compensation insurance, as requlrod by'Secdon 3700 of to Labor Code. for the performance of the work for which this permit is
wo rs' oar hsation.hisurance carrier and poC�,y�ymber are:
Carrier _19=1P.. •., a Pdiq Numtber
I,oertrfy that in the Perbf.i of the work for which this pommit fs ued. lI shaq� person in any mar►ner so as to beoon>a subject is the wakes'
focompenrthwith
comply
laws of Califhose pr la, and agree that W.] stoohAd beoortq subject b the workers' Compensation provisions of Section 3700 of toe Labor Code, l Shad
oorrply with those Drovt�ons. : .
.L SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
COMPENSATION, DAMAGES AS PROVIDED FOR IN
1 hereby affirm under penalty of perjury that there is a co CONSTRUCTION LENDING AGENCY
nslruction lending agency for tme Performance of the work br which this Permit Is Issued (Sea 3097. Cb. C.).
Lenders Name
Lenders Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
Application is hereby madeto the Director of Butiding aA
for perNtsubieci to tine conditions and restrictions sat forth on tole application.
1. Each Person upon whose behalf tris application k made. on
Issued as a resole of this appiicattah, the owner, and the a
officers, agents and employees for any act or omission rele.
and for whose bemertt work k perfomos0 under or pursuant b an mNt
�
uprose b and shat. defend, ass City of La Qukda.its
Indemnify alssuance
2 Y Pew Issued as a result of this application becomes ol
of work for 180 days ain subject'permit to
�0 ormed undef a f of
wont fs oormnhenoed wtthir►.180 days from dale of I�sstranure of such pemtit acessation
ca 1 Cetttfy that 1 have read tris apptir�ution and state that the aboveo
canstnution,and hereauthorize representatives of this county
to cortply rrlth ell clty end county ordirwnoes and state laws.relating to budding
a tioned property for inspection purposes.
Date Ol u Signature(Appkent or Agency
Page 2
Application Number 04-00006850 Date 10/20/04
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 f 15.00
Special Notes and Comments
POOL & SPA. -BBQ ANSI Z21-58-1995.'
5 LF 4' BLOCK'WALL'PER CITY STND.
ALARMS/BARRIERS SHALL BE IN'PLACE PRIOR
TO PREPLASTER INSPECTION.
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Fee summary. Charged Paid Credited Due
Permit Fee Total :106.00-- .00 .00 30.6.00
Plan Check Total 148.35 .00 .00 148.35
Grand Total 45'4.35 .00 .00 454.35