04-3551 (RPL)wt92 P
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CITY ®F .:UIQJ3A BUILDING &.SAFETY DEPARTMENT
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P.OIt�B:UX-150 (7.60) 777'4012
Of 9 1v�78--4495 CALLS TAMPICO' FAX ('760) 777-7011
LA .Q.UINTA, CALlFORN.IA 92253 INSPECTION REQUESTS (760).777'-7153-
BUILDING
760)'777-7153BUILDING PERMIT ------ ---,j
Application Number 04-00003551— Date 4/16/04
: Property Address 80620�VIA ALAVERA
APN: 772=50 -999-134 -30357
Application description• POOL - RESIDENTIAL-
" Property Zoning LOW DENSITY RESIDENTIAL
Application valuation ' 180,00
:Owner Contractor'.
TOLI{. CA V CAL'IFORNIA.'POOLS. & SPAS
C/O KEVIN D DUERMIT n:.,. P. -O. BOX 1280
8901 E"... MOUNTAIN VIEW 200 "COACHELLA CA 92236..
SCOTTSDALE AZ 852.5.8 (760):.39.8=9222
:.•..:
W
WCC:,..STATE FUND..'.•
04600;06.1168 01/01/05
::......:CS.LB. : 1.28 10/31%04
. •'6 5 6
- - -
.77
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. 0.0
1'.00 9.0000 EA MECH FURNANCE <'100K. 9.00 .
------.--
------•------------------ = ----- - - - - -- --r----- .---- - - --.--=.----- .-
Permi.t:.. BLDG -POOL.- PERMIT
Additioria'1 desc
Permit.,Fee 189.00 Plan Check Fee 122.85
Issue Date. Valuation 18000
Qt Unit Char e Per'. Extension
Q. Y g
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 45.00Plan'Check Fee .11.25
1 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
UWA VOCE (760) 777-7012
78-495 CALLS TAMPICO FAX .(760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
Application Number. D Y
Applicant:
Applicant's Mailing Add
BUILDING & SAFETY DEPARTMENT
Date:
Architect or Engineer, '
.Architect or Engineer's Address:
Uc. No..
BUILDING PERMIT DECLARATIONS .
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury Crap 1 am licensed under provisions of Chapter 9 (comnrenoing wtth Section 7000) of Division 3 ot the Business ,Professsionals
Code. and my License in force and affect.
License Lroense No.
Class
Date • cormtractor
E7R-Bu1LDER DECLARATION
.I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the Wowing reason (Sec. 7031.5. Business and Professions Code: Any
city or county that requires a pemrit to construct, after. improve. demolish, or repair any structure, ixioi to its Issuance. also requires the applicant for the permit to tda a signed
'statement that he of 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 fiat he or the 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 cavi penalty of not more than five hundred dollars (5500).):
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, howeyer. the budding or improvement is
sold within one year of completion. the owrw4xulder 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.3 P.C. for thisreason
Date` Owner
WORKERS' COMPENSATION DECLARATION
1 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. forte perfornanoe
of the work for which this permit is issued.
_ I have and will intatrm workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
sue .nay kers' npensation Insurance prier and policy r�u�mb�r are• `
Carrier � Picft Number Ll f/ 6 ow (P/16t
_ I certify that in the performance of the work for which this permit is issued, I shad not employ any person in any manner so as to become subject b the workers'
compensation laws of Cakfomia, and a that, If I should become subject 10 the workers' compensation provisions of section 3700 of the Labor Code, I slue
bftw th. Wmply with those
Date , 2I -o Applicant i c
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION d6VERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE IiUNDRED THOUSAND DOLLARS ($100.000). 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 fop the performance of the work for which Chis pemdt is issued (Sec. 3097. Civ. C.).
Lendees Name
Lenders Address
IMPORTANT Application is her APPLICANT ACKNOWLEDGEMENT
hereby made to the Director of Budding and Safety for a -permit subject to the conditions and restrictions set forth on this application.
1 • Eaas a msuft of chwhose os behalf this application is made, each person at -whose request and for whose benefit work is performed under or pursuant to. any permitpplication, the owner, and the applicant, each agrees to, and shad, defend, indemnify and hold harmless the City of Le Ouinta, its
officer;, agents and employees for any ad or omission related to the work being performed under or following issuance of ttds permit
2. Any penrdt issued as a result of this application becomes null and void If wok 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.
Iconstnx tionI have read end hereby asapplication and st representaUmt the tives of this above information Is correct 1 agree to comply with all
city and county ordinances and state laws relating to building
% county to enter upon the above-mentioned property for Inspection purposes.
Date c J -d I Y Signature (Applicant or Agent): t
Page 2
Application Number
04-00003551
Date 4:/16/04
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 ONLY. 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
439.35