04-6514 (RPL)n
BUILDING & SAFETY DEPARTMENT r
P.O. Box .1504 (760).777-70:12
78-495 CALLE TAMPICo ' FAX (760) 777=7011
LA QUINTA, CALIFORNIA .92253 INSPECTION REQUESTS (760) 777-_7153 .
BUILDING: PERMIT
Application Number 04-Q'0006,514 Date 9/29/04
..Property -Address:-. .x,56985 VILLAGE DR
-�-
..APIC: 764-060-004- A;
Application:description POOL. -_..RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation..': 18000
Owner Contractor � rYOlr;WgUINTA
--------------------------- --- ---- ------ --
MARGULEAS.YOUNG HOMES CALIFORNIA POOLS & SPAS
C/0 AVAILPROPERTYMGT. P.O.. BOX .1280
P �.O .BOX 1032' COACHELLA CA .9.2 2 36 ..:
PALM, ''DESERT .'._:.. .,.CA 92261... (760) x398-.922.2... r;>
WCC.:: STATE FUND :
WC:` 04600:0.61168 01/01/05 ,
C.SLB':: 6.56128: 10/31/04:
CCC: C.8=C27=C29;-.C53
- - - - - - -
----------- -------------------- --------------'------
Permit'
-----Permit MECH POOL.
Add-itional desc 1
Permit.. Fee 24.00 Plane Check Fee 3.75
Issue Date Valuation 0. ".
Qty" Unit Charge'. Extension
BASE F'EE ...
15.00
1:0.0 9.0000 EA MECH FURNACE <=10.0K9:00
Permit BLDG POOL PERMIT
Additional.desc
Permit'Fee..:. 189:00 Plan Check.`-Fee:122:85
Issue. DateValuation.-: - 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: :Fee 11:25
Issue Date: Valuation 0
Qty Unit Charge Per Extension
BASE FEE' 15 00,
P.O. BOX 1504
78-495 CALLE TAMPiCO
LA QUINTA, CALIFORNIA 92253
Application Number. D
Applicant:
Applicant's Mailing Address:
VOICE (760) 777-7012
: FAX (7 60) .777-7011
INSPECTION$ (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Date:
Architect or Ehginee .
Architect or in r Address•
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 (coo. in g with Secdon 7000) of Division 3 of the'8usiness and Professionals
Code, and my Licensgis in full fore and effect..
Lioense Class_ Lam. 53 License No. 12 0
Date f/ &4 Contractor `
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sea 7031.5. Business and Professions Code: Any
city or county that requires a pemilt to const uct, alter. Improve, demolish, or.repair any structure. prior to Its issuance, also requires the applicant for the. perm t 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 ) or.that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Sedan 7031.5 by any applicant fora permit subjects
the applicant to a civil penalty of not more than fire hundred dollars ($500).);
(, I, 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 (Sea 7044,
Business and Professions Code: The Can ;'S S to 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 emplo . . provided -that the Improvements are not Wended cr offered for safe. H, however, fie budding or 4rgxoveni6nt is
sold wil iiri one year of completion, the owner -budder the burden of proving
(, I. as owner of the property, am axil that he or she did not build or knprove for the purpose of solei.
exclusively contradin U tredore to construct the project (Sea 7044, Business and Professions Code: The Contredors'
State License Law does not appy to an owner of rty who bui s or Improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License
(, 1 am exempt under Sefor thl n
Sec. PSC. ^
Date
--i—WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perju one of th edarstlons:.
_ t have and.will maintain a certificate of consent to self -Insure for workers' compensatlon, as provided for by Section 3700 of the Labor Code, for 0* performance
of the work for which this permit is Issued..
I have and will maintain workers' compensation Insurance, as required by'Sedion 3700 of the Labor Code, for the performance of to work for which this permit Is
Qq MY rs, cone _ _nsatlon.ihsurance carrier and pr�y�er aro:
Carrier 'f P •_ , Policy Number O �/(o�/YM � ///e
_ I.Certify that, in the performance 01 66 work for which this pertNt is issued; I shall not employ any person in any manner so as to become subjectla the workers'
compensation laws of California, and agree that, If. 1 should become subject to the wftW compensation provisions of Section 3700 of the Labor Code, l Shan
forthvdth comply with those provIVgns.
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 06LLARS ($100.000).;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 them is a construction tending agency for the performance of the work for which this permit Is Issued (Sea 3097. Civ. 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 end restrictions set for on Ws appdcatkxi.
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 "a to, and shall, defend. Indemnify and hob twmless the City of Le Quints, its
officers, agents and employees for any act or omission related to the.-" p Warned. under or following issuance of this pernaL
2 . Any permit Issued as a result of this application becomes nun and void If commenced within days from date of Issuance of such permit, or
cessation of work for 180 days will dubjed permit to cancellation.
certify that I have read this application and state that the above Inf tion Is I agree comply with an city and county odtnanoea and state lawn relating m bonding
construction, and hereby authorize representatives of this county ter property for inspection purposes.
Date Signature (Applicant of Agent):
-
I
'Page 2
;Application Number . . . 04-00006514 4
Date 9/29/04,
Qty Unit Charge, Per-
j Extension
1.0.0, 30.0000 EA ELEC_PRIVATE SWIMMING'POOL!
30.`00
--------------------•-----------,-----------.----
PermitPLUMBING
---------- - - - - -- .
Additional desc
Permit Fee 33.00 Plan -Check Fee;..:
8.25
Issue Date Valuation
0
Qty Unit Charge Per
Extension`
BASE FEE
;. 15.00
2100,' 6.0000 EA., PLB FIXTURE
; 12.00
1:00. 3.0000 EA PLB WATER '-INST/ALT/REP
l 3..00
1.00 3.0000, EA PLB GAS PIPE 1-4 OUTLETS
{ 3.00 ,
-----------------------------------------
Special Notes and Comments
--- -
POOL . & SPA. WATER• FEATURE . BBQ
ANSIlZ21=58=1995. ALARMS BARRIERS SHALL..'
BE IN. PLACE PRIOR TO'PREPLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN_ PERMIT.
Fee. summary Charged Paid: - Credited
--
- ------ - - --
Due
.- -- - ----------------- - - - - -.--- - - - --
y Permit•Fee.Total 291.00 00 00
---- - - - - - -
291.00
Plan Check .Total 146.10 .00 .00
r 146.10
Grand Total 437.10 00 :00.
437.10
",:v
,.
,. ....
.. ... , ,. .. .. ., ..., ... �. ., ..... , r
,
-oil.- , x__T
. �s..,:.
a-,. ..... u_,. .... _, , `� ,_.: o. <<..�... .�_<�...Wsy:s.:,.::.....n�,,,....a. w..e..k. e�.x:„t. ,,.. a 'L..,,.. .:.�. :,.>..�.,.,... �,..u... r. r....,:. "._-. .,..;_ c _ ., ..,� '.. .. .... , ..,_. >.. a- . � :- +....,:. „-, .,-. .,. .,..: a- , .. n_, , .. .. .-..m::.. .. rr..,:..x', ,. , „, �,,.. . :;:: ...,. _,,.... , _:..a..,_.r..- . „�_.ar,' ,...m ::.:....... .-.. ..F... ,: ...., n 1,_:♦..,.::_....aa.a......:;1..........3.uw..�..,.,_:-.._.,
VIA
..,.,...xs .
.i
.
m,
d,..
;, _. _ _.. ., � ,.�_ amu..._ - ,♦xw..t-:.iiauuau�....>�L. a.. :
,� ,_ . .Y.w.-_..c. �._.._ '. _:z.�. _,_.u.rn...ae,., ,. du ,_ ._. ,.. ..._ .. , _.....w. ,:.. r. n ,r. ... t >z.,._ v, , r .:r •f
--. ..__ _ .-w-, ..i'm,. C�iiv 5. a4 a,.Sdti:.4F'Y,.t....r�,. •'-:
,