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04-5605 (RPL)o� V � BUILDING & SAFETY,DEPARTMENT P.O. Box. 1504 (760).777-7012 'OF Tt�9` 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 \ INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number : . 04---0,0_ 0.0:5.60; Date` 7/22/04 Property Address . . . 7932-9--CALLE VIST (� ERDEa APN: 604-392-050-91 2!•_ -3 Application description".,. POOL - RESIDENTIAL Property Zoning . . LOW DENSITY .RESI iE �TIAYIL 26 Application valuation, 18000 2Qo4 . CITY OF LA QUINTA Owner Contracto FINANCE01_PT BOHRMANN WILLIAM H,I CALIFORNIA'PCOLS & SPAS Ft -LE -77.32q V CA�6E VISTA &&DE P.O.,.BOX 128C -UNI=10N 4A 4?u1N,r4 CA 9.999 g2Z5-3 COACHELLA CA 92236 (.760) 398-9222 WCC: STATE FUND WC: 046010061168 01/01/05 CSLB: 656128 10/31/04 CCC: C8 -C27 -C29-053 Permit. . . . . . . BLDG POOL PERMIT Additional desc Permit Fee 189.00,' Plan Check Fee 122.85 Issue Date Valuation 18000 Qty. Unit Charge. Per Extension BASE FEE 45.00 16.00 9.0000 THOU BLDG 2,.001-25,000 144.00 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 15.00. 1.00 9.0000 EA MECH FURNACE <=100K 9.00 ------------------ 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 •1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 P.O. Box 1504•�/ VOICE (760) 777-7012 78-495 CALLE TAMPICO 4,41 FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 a INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: S 6,05 Date: Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICEN CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under p ovi ons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Lice�sa is�'o II force and effect. / n/ /License Class C —S _ . Nn 4 ,5 % %X Date t / O WNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the�Coors' 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, dor 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 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 safe (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 safe. 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. B.& P.C. for this reason Date 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 erscompensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issyyeed. workers' c pensation insu�ance carrier an c rgkeyar�l rier % fP u (, acv Number [J (rJ G I certify that, in the performance of the work for which t s rmit issued, sued, I 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 h uld beco a subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall /forthwith comply with those provi ' ns. Date l � LC--Xpplcant WARNING: FAILURE TO SECURE WORK RS' COMPENSATI N C ERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($10 , 00), 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 —9r— I 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 sh efend, indemnity and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission related to the work being erfo ed and r or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work i not mmen 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 information is correct I gre to comp��th all city and county ordinances and state laws relating to building construction, and /hereby yauthorize representatives of this county to en r upon the ov a tinned property for inspection purposes. ( ature (Applicant or Agent): Page. 2 Application'Number . . . . . 04-00005605, Date 7/22/04 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. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. -EQUIPMENT ENCLOSURE NOT INCLUDED 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 43.9.35 00 .00 439.35 i SALES FIELD DIG PRE-GUNITE UNDERGROUND MASONRY DECK PRE -PEBBLE i