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04-6511 (RPL)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-70,12 78-495 CALLE TAMP.ICo ' FAX (760) 777=7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 . BUILDING. PERMIT Application Number 04-0.0006511 Property Address:... 5696.1_. VILLAGE DR APN: 764 -0,60 -057 - Application description POOL RESIDENTIAL Property.Zoning . . . . . LOW-DENSITY RESIDENT ..Application valuation ,. 18000 Date 9/29/04 Owner.: Contractor -�� ----------------------------------=-- ------- -- M/M GUTIERREZ CALIFORNIA POOLS & SPAS P.O. BOX .1280 56.-.961 VILLAGE DR*COACHELLA CA 9.2236 LA QUINTA CA 9225.3: .(760) 398-.9222.. o; WCC:. STATE FUND WC;`.04600.061168 O1/01/05< CSLB: 656128 10/31/04-,- CCC: C8 -C27 -C29-053,. -- --- -------- ----.---------------:= Permit MECH POOL Additional desc Permit. Fee 24.00 Plan Check Fee 3.75'`; Issue . Date 'Valuation 0. a `` Qty ..Unit Charge Pe;r Extension . BASE FEE :.. • 15.0:.0. 1.0.0 9.0000 .EA MECH FURNACE :<=100K 9.00 Permit BLDG POOL PERMIT Additional .desc Permit .Fee 189.00 Plan Check Fee'. 122'.85 Issue.Date Valuation 1800.0 Qty. Unit Charge Per Extension "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. 45.00 Plan Check: Pee 11:25 Issue Date Valuation* .0 Qty Unit Charge Per Extension BASE FEE 15.00. P.O. BOX 1504 a� r VOICE (760) 7.77-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION$ (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number. Date: . Applicant: I Architect or Engineer I , Applicant's Mailing Address: Uc. No.: or BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the'Business and Professionals Code. and my Lioenag,Is in full force and effect / �/ �� Q License pass L-- 53 License No. 4p (o 0 Dale.�� Contractor 41�t� hereby affirm under penally of perjury that 1 am a OWNER -BUILDER DECLARATION xempt from the Contractors' State License Law for the Mowing reason (Sec. 7031.5. Business and Professions Code Any city or county that requires a permit to construct, alter. 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 DMsion 3 of the Business and Professions ) or that he or she is exempt therefrom and the basis for the alleged exemption, Any violation of Sedian 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fore hundred dollars (=500).); U I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure knot Intended or offered for sale -(Sec 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 Improvements are not intended or offered for $ale. H, however. the building or Improvement Is" sold within one year of completion, the c wner4Ader will have the burden of proving ghat he or she did not build or improve for the purpose of sale.). U 1, as owner of tha property, am exclusively contracting with licensed contractors to oorstrun t the project (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 contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. B.& PSC. for this reason Date Owner_ WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury line of the following declarations:, _ t have and.wnl maintain a certificate of consent to selfansure for workers' Cornpensetion, as provided for by Sedan 3700 of the Labor Code, for the performance of the work for which this permit is Issued.. Idmave and will maintain workers' compensation insurance, as required by'Sedlon 3700 of the Labor Code, for the performance of the work for which this permit is P wo"rs! com ensation.lnsurance carrier and Carter pr�ymber aro: - _ , Policy Number _ O y(o�%y) I.Ceftify that in the performance of the work for which this'pemnls issued, l shall not employ any person in any manner so as to become subject to the workers' compensation laws of California. and agree that If I should beoome subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall j forthwith comply with time ns. J 4� natty / 6 / l% A0% e.. n .. %�/A/i!// WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DbLLARS (S1oo,000). IN.ADDMON 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 agancy for the performance of the work for which this permit Is Issued (See. 3097, CN. C.). Lenders 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 appncation Is made, each person at whose request and for whosebenefit work Is performed under or pursuant to any permit Issued as a result of this application, the owner, and the applicant, e s to, and shag, defend, Indemnify and hold harnless the City of Le Oulnta, its officers, agents and employees for any ad or omission related to beim -under or following Issuance of this pemmiL 2 Any permit issued as a esuft of this application becomes nun and d wok Is rot commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. A 1 certlythat I have read this application and state that the above Inn rmation is I egree to comply with an city and County ordinances and state laws relating to building construction, and hereby authorize representatives.of this county enter a boned property for Inspection Purposes. Date L" r Signature (Applicant or Agent): Page 2 Application Number 04-00006511, Date 9/2'9/04 Qty Unit Charge Per Extension 1'.00 30.0000 EA ELEC PRIVATE SWIMMING,POOL .30.00 Permit: PLUMBING Additional desc: Permit Fee 33.00 PlaniCheck 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 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 Comment POOL,,& SPA. WATER FEATURE. BBQ -ANSI Z21-5871995. ALARMS BARRIERS SHALL BE IN,PLACE PRIOR TO.PREPLASTER INSPECTION.•EQUIPMENT ENCLOSURE NOT ` INCLUDED IN PERMIT. Fee :summary Charged Paid Credited --=------------- Due ------------------------------ Permit Fee Total 291.00 , ."00 .00 ---------- 291.00 Plan Check'Total 146.10 .0"0 ."00 146.10 Grand"Total 437.10 .00 .0.0 437.10