04-6661 (RPL)o .
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
c��tpIF'9 _ 78=495 CALLE TAMPICO '. FAX (760) 777-7011'
►�„
LA_QU'ITA, CALIFORNIA 92253 INSPECTION REQUESTS (7.60) 7774153
�. BUILDING PERMIT' _
r `��
Appli�ca� 1' oriNumber �:= 04-0000666 - Date 10/08/04
P-_reperty Address `--"0830 VISTA LAZO � '
APN: 762=250 -
Application description . . . POOL- RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation 30000
Owner Contractor
PIERRIE & KATHYRN LETHLIER CABINETS BY PRECISION WORKS
81101 INDIO BLVD, SUITE #D-18
81101 IN'DIO BLV INDIO CA 92201
INDIO CA 92201 ,(760) 342-1133
WCC: STATE FUND..
WC: 1576886 01/'01/05
CSLB: 768922 09/30/05
CCC: B
Permit MECH POOL
Additional desc
Permit Fee 2.4.00 Plan Check Fee 6.00
Issue Date . . . Valuation 0
Expiration Date 10/08/05.
Qty Unit Charge Per Extension
BASE FEE 15.00.
1..00 9.0000 EA- MECH FURNACE <=100K 9.00.
Permit. BLDG POOL.PERMIT
Additional desc
.Permit Fee '284.50 Plan Check'Fee 184.93
Issue Date . . Valuation 30000
Expiration Date 10/0.8/05
Qty Unit Charge Per Extension
BASE FEE 252.00
5:00 6.5000 THOU BLDG 25,001-50,000 '32.50
Permit ELEC POOL PERMIT=RES
Additional desc
Permit Fee 45.00 Plan Check Fee 11.25
Issue. Date Valuation 0
Expiration Date 10/08/05
P.O. BOX 1504 '���
78-495 CALLS TAMPICo VOICE (760) 777-7012
LA QUINTA, CALIFORNIA 92253 4 4 FAX (760) 77-9-7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: I Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Lic. No
MUILUINU PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my. Licen in full force and effect'. �� 9 ^ r�
License Class License No. / c p(
Date, /O= y C0
t-
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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, 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 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 I 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.
1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
s e My wort„�Ls' compeer safion insurance carrier. a pol, rre
:
Cartier 57 i �P J_V J_JCi' Policy Number. 7YO f Ve
_ 1 certify that, in the performance of the work for which this permit is issued, I shall not em to
p y any person in any manner so as to become subject to the workers'
compensation laws,,,,. of California, and agree that, if I should become subject to tjorkers' compensation provisions of Section 3700 of the Labor Code, I shall
,^�
forthwith comply witse pion .
Date v '� 7- / Appli
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 DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
CONSTRUCTION LENDING 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
Lender's 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, indemnify and hold harmless the City of La Ouinta, 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 work 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.
I certify that I have read this application and state that the above inform • ' rect. I agree to comp) ' II city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county nter upon t e above�m ntione roperty r inspection purposes.
Date 10 Signature (Applicant or A nt): /� r
Page 2
. Application Number•.. 04-00006661
Date 10/08/04
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00' 30.0000 EA ELEC,.PRIVATE -SWIMMING POOL..
30.00
----------------------------------------------------------------------------
Permit . . . . PLUMBING'
Additional desc
Permit Fee 27.00 Plan Check Fee
6.75
Issue Date . . . Valuation
0
Expiration Date 10/08/05
Qty, Unit Charge Per
Extension
BASE FEE
15.0.0
1.00 6.0000_EA PLB FIXTURE
6.00
1.00 .3.0,000 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 ONLY. FRONT FOUNTAIN- 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 380.50- .00 .00
380.50
Plan Check Total.. 208.93 00. .00
208.93
Grand Total. 589.43 .00 00
589.43
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