04-5228 (RPL)Tait,
°F:Ww
BUILDING & SAFETY DEPARTMENT',
P.O. Box 1504 (760).777-7012
78=495 CALLS, TAMPICO FAX (760)'777-701 1
LA QUINTA, CALIFORNIA 92251 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number 0-4--0-0-0,0_522:8 'Date 6/29/04
Property Address . . 56-9-33 VILLAGE DR -
APN: 764-0.50-029-70 -28983 -
Application description . . POOL - RESIDENTIAL
Property Zoning . . . LOW DENSITY -RESIDENTIAL
.Application valuation 17000
Owner Contractor
BIRDIE HOMES LLC CALIFORNIA POOLS & SPAS
5 E. CITRUS STE. 205 P.O. BOX 1280
REDLANDS COACHELLA CA 92236
REDLANDS, CA 92373 (760) 398-9222
WCC: STATE FUND
WC: 04600061168 01/01/05
CSLB:, 656128 10/31/04
CCC:'. C8 -C27 -C29-053
Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Pee 180.00 Plan Check Fee 117.00
Issue Date Valuation 17000
Qty Unit Charge Per Extension
BASE 'FEE 45.00
15.00 9.0000 THOU BLDG 2;001-25,000 135.00
------------------=-- --------------- ----------------
Permit. . . . MECH POOL
Additional de.sc
Permit Fee 24.00 Plane Check Fee 6.00
Issue Date Valuation_ 0
Qty Unit Charge Per Extension
BASE FEE 15.00'
1.00 9.0000 EA MECH FURNACE <=100K 9.00
--------------------------------- ----------------------------------------- Permit . . . . . . ELEC POOL. PERMIT -RES
Additional desc r D
Permit Fee . . . 45.00 Plan .Check Pee 11.25
Issue Date Valuationo��oo� 0
Qty., Unit Charge Per Ext.enson
BASE FEE
P.O. BOX 1504
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4 4 a"
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: (jl.�• Sa�
Applicant:
Applicant's Mailing Address:
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LC D CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under vision f Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Licer}§e is . f force and elle
_License Clas/s �G ��j i n e
Date_ (` L - ontractor
�ER'BUILD is DECLARATION
I hereby affirm under penalty of perjury that I am exempt frothe Contra ors' 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, , 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 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 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 1 am exempt under Sec. , BA 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 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 and will maintain w ers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
workers' c pensation insrance carrier a icy um . r
artier iss ed. M olicy Number
_ I certify that, In the peArfotmance of the work for whiclf Ihis permit's issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree�' at, I hould be me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those p0%sions.
WARNING: FAILURE TO SECURE WO KERS' COMP TIO COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR 0,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LEM)ING 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
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.
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, indemnity and hold harmless the City of La Quinta, 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 rk 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.
1 certify that I have read this application and state that the above information is oo 1 g to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize repro ntatives of this cdunty t ter upon ot.v boned property for inspection purposes.
Date ! [ �� ignature (Applicant or Agent):
Page 2
Application Number . . . 04-00005228
Date 6/29/04
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
15.00
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. ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION..
EQUIPMENT ENCLOSURE NOT INCLUDED
Fee summary Charged I' Paid Credited
Due
Permit Fee Total 282.00 00 .00
282.00
Plan Check Total 142..50 .00 .00
142.50
Grand Total 424.50 .00 .00
.424.-50`