04-3837 (RPL) Revision 1!I.
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BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760). 777-7153
BUILDING PERMIT
Application Number . . . . . 04-00003837 Date.
5/14/04
Property Address . . . . . . 79330 BRIARWOOD
APN: 772-020-009-8 -26524 -
Application description . . . POOL - RESIDENTIAL
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 25000
Owner Contractor
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LA QUINTA ORCHARDS PARTNERS CALIFORNIA POOLS & SPAS
C/O LA QUINTA ORCHARD PARTNERS P.O. BOX 1280
P 0 BOX 1716 COACHELLA
CA 92236
LA QUINTA CA 92253 (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 . . . . . . BUILDING PERMIT
Additional desc
Permit Fee . . . . 54.00 Plan Check'Fee
35.10
Issue Date . . . . Valuation . . . .
3000
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
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Special Notes and Comments
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POOL/SPA WITH BRIDGE (PER CALLS) ON
SEPERATE.PERMIT. PLUS WATER FEATURE
WITH 2ND SPA. ALARMS/BARRIERS SHALL BE
IN PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT.ENCLOSURE NOT INCLUDED.
5/14/04 3:01:36 PM jschmidt - BUILDING
PERMIT CREATED FOR CONSTRUCTION OF
BRIDGE ONLY PER SEPERATE APPROVED PLAN.
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Other Fees .. . . . . . . . ENERGY REVIEW FEE
3.51
Fee summary Charged Paid Credited
------------------------------------=
Due
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Permit Fee Total 54.00 .00 .00
54.00
Plan Check Total 35.10 .00 .00
35.10
P.O. BOX 1504 T -VY
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or
Lic. No..
BUILDING PERMIT DECLARATIONS
VO �e (760) 77 7 -70 12
NX (7 60) 777-7011
INSPECTYONS (760) 777-7153
Date:
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that 1 am licen5V under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License is in full f rce and effect.
�
License Class `�'T'� Licen No.
Date ' 2 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 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 sale 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 1, 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:
�hhave 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
the work for which this permit is issued.
e and ill mai fain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is ue My w rs' c pensation insurance carrier and policy nurpggr �rey� ®� /!��
Carrier Policy Number j'% Y (f�
I c ify that, in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,a agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those pro ion01
.
Date Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSA ON 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 Quinta, 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 Aiformation is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this cou enter on the above boned property for inspection purposes.
AI
Date " l/J`� Signature (Applicant or Agen