04-6221 (RPL)Tdf 4 4V a"
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
Application Number . .
Property Address . . .
APN:
Application description
Property Zoning . . . .
Application valuation .
Owner
IVANHOE LA QUINTA COVE
C/O R BARRY MCCOMIC
7979 IVANHOE AVE STE 550
LA JOLLA CA 92037
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
04-00006221 Date 9/09/04
77956 GREY WOLF TR
658-140-999-87 -29436 -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
17000
Contractor
CALIFORNIA POOLS & SPAS
P.O. BOX 1280
COACHELLA CA 92236
(760) 398-9222
WCC: STATE FUND
WC: 04600061168 01/01/05
CSLB: 656128 10/31/04
CCC: C8-C27-C29-053
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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
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Permit . . . . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 180.00 Plan Check Fee 117.00
Issue Date . . . . Valuation . . . . 17000
Qty Unit Charge Per Extension
BASE FEE 45.00
15.00 9.0000 THOU BLDG 2,001-25,000 135.00
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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 �� VOICE (760) 777-7012
T4hf
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Ly vZ Date:
Applicant: Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Ad re
Lic. No.:
BUILDING PERMIT DECLARATIONS
SED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed Lind provi 'ons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Licew is II force and effect. License Class k- ` L' e se tV p>�! r
r
Date 1p 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 (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 700D) 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 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 rc�.ason
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.
I have and w111 maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
a Lie My war s compensation insurance carrier a licy,nu er
Carrier�Z( 1'alicy Numb (/,�
I certify that, in the performance of the work for ich this rmit is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree L if I sh Id become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those isions.
Date idly Applicant
WARNING: FAILURE TO SECURE WO KER CO N COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED T OUSAND 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 Bullding 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 Qulnta, 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 commenced within 180 days from date of issuance of such permit, or
cessation of work for 150 days w111 subject permit to cancellation.
I certify that I have read this application and state that the above information is corre . I gree comply with all city and county ordinances and state laws relating to building
construction,, and hereby authorize representatives of this county tc ter upon the hove• en oned property for inspection purposes.
Date !6 G Signature (Applicant or Agent): , �
Page 2
Application Number .
. . . 04-00006221
Date 9/09/04
Qty Unit Charge
Per
Extension
1.00 30.0000
EA ELEC PRIVATE SWIMMING
POOL
30.00
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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
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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
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Special Notes and Comments
POOL & SPA. 15 LF 4'
BLOCK WALL CITY
STND. 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
Grand Total
439.50 .00
.00
439.50
i MG
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BOULDERS
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-- DECK COL,
GO
JANDY
'EBB./PLAS
SIGNATURE _
DRAINAGE NOTE: Drainage and. it—ri �jtio . f-, P!eomter ;; arid :pots, b
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