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04-8026 (RPL)Tihf °F 4Waulxrw P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number Property, Address . . . APN: Application description Property Zoning . . . . Application valuation BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION. REQUESTS (760) 777-7153 04-00008026 Date 12/28/04 77949'GREY WOLF TR 658-140-999-101 -25436 - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 17000 Owner Contractor IVANHOE LA QUINTA COVE CALIFORNIA POOLS & SPAS C/O R BARRY MCCOMIC P.O. BOX 1280 7979 IVANHOE AVE STE 550 COACHELLA, CA 92236 LA JOLLA, CA 92037 (760)398-9222 WCC: STATE FUND WC: 04600061168 01/01/05 CSLB: 656128 10/31/06 CCC: C8-C27-C29-053 P.O. Box 1504 •f`■ VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 04 - FUj (�, Applicant: Applicant's Mailing Address: Date: l ' L/'05 Architect or Engineer: Architect or Engineer's Address: Lic. No.. 'BUILDING 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 ode, and my Li se • 'rLph force and effect. License Class c se 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 Cade, Any city or county that requires a permit to construct. attar, 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 end Professions Cod--) or that he or she Is exeimpt t7ar'e,`vT and the his for tore miieged exemption. Any viaiadon of section 703 1. 5 by any applicanl for a pem* subjects the applicant to a civil penalty or not more than five hundred dollars ($500),): [, j I, as owner of the property, or my employees with wages as their sole compensation, Wil do the work, and the structure is not intended cr 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 fhat 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 sate.). (, I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code' The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractors) licensed pursuant to the Conlractors' State License Law.)- U I am exempt under Sec. , RA P.C. for this reason 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 ffrkers' compensatio surance. as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is `' issy�d. arkerspensation nce caer arid policy number a arrier =mot -ff ,� alicy Number us I certify in the pe ormance of the wank for which this permit is issued,T shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agrees if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shad forthwith comply with those provisions. j ,e Ile) S WARNING: FAILURE TO SECURE WORKERS' CO6%fN ATIO COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLA 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 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.). Lenders Name Lenders Address f ' 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 Quinta, its officers, agents and employees for any act or omission related to the workbeing performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void it 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 information is I a to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorize representatives of this county tG enter upon a -mentioned property for inspection purposes. /Date Signature (Applicant or Agent): ---------------------------------------------------------------------------- Application Number . ---------------------------------------------------------------------------- . . . . 04-00008026 Permit . . . . . . BLDG POOL PERMIT Additional desc . . Permit Fee . . . . 180.00 Plan Check Fee 117.00 Issue Date . . . . Valuation 16760 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 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 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 Permit . . . . . . WALL/FENCE PERMIT Additional desc . . Permit Fee 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 240 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments POOL & SPA , 15 LF OF 4' BLOCKWALL CITY STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. Fee summary Charged Paid Credited Due Permit Fee Total 297.00 .00 .00 297.00 Plan Check Total 142.50 .00 .00 142.50 Application Number . . . . . 04-00008026 Grand Total 439.50 .00 .00 439.50