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04-7404 (RPL)60132 Angora Ct G TAMPICO ALIFORNIA 92253 Application description Property Zoning . . . . Application valuation . Owner BUILDING PERMIT 1111111111111111111111111 20 BUILDING & SAFETY DEPARTMENT (760) .777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 . 04-00007404 Date 11/22/04 . . . 60132 ANGORA CT 764-270-999-114 -300233- . . . POOL - RESIDENTIAL MEDIUM HIGH DENSITY RES . . . 17000 SHEA LA QUINTA C/O JEFF MCQUEEN 8800 N GAINEY CENTER 350 SCOTTSDALE AZ 85258 Contractor CALIFORNIA POOLS & SPAS P.O. BOX 1280 COACHELLA CA 92236 (760) 398-9222 WCC: STATE FUND WC: 04600061168 01/01/05 CSLB: 656128 10/3.1/06 CCG: C8 -C27 -C29-053 -----------------------------=---------------------------------------------- Permit . . . . . . MECH POOL Additional desc Permit Fee . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE PEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 ---------------------------------------------------------------------------- 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 4 5 .'0 0 15.00 9.0000 THOU BLDG 2,001-25,000 135.00 ---------------------------------------------------------------------------- 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 P.O. Box 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: d - Date: Applicant: Architect or Engineer: Applicant's Mailing Address: Architect or En 6Z Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed er�pvisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Liceryae is'i�utt�force and effect/��/��License Class [— ,� n iceno. 4 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 permii 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 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 contractin w' the Contractors' State License Law.).). sed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply an owner ofp perty o builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to U I am exempt uncle Sec. , B C. for this r aso 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. havS and will maint9q workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is is work ' compensation insurance carier n -_y pyptipg� /�� Cariers Policy Number (%CJ' _ I certify that, in the performance of the work for which this pernit is issued, I shall not mploy 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 the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date Applicant 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 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 's not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. 1 certify that I have read this application and state that the above information is ed. I a ee to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county nter upon t e abov mentioned property for inspection purposes. Date Signature (Applicant or Agent): I 13 Page 2 Application Number . . . . . 04-00007404 Date 11/22/04 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 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 Alov �J-1 A"v t> PA A -i -k- %V' "I -T$4 TNA, C&P, -JF7osEv- -To A-Jv CiviiLVeV- yAA,"VMML- -To wcoA -T41GK CV -T i rl W CC)Ibjbl.-C CotAibO ACi Ps A, PAO wl ADQ WALK v PRI-TI-BBIt