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04-7714 (RPL)T4hf 4 4 a" P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760) .777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . . :' 04-00007714. Date 12/09/04 Property Address . . . . . 57605 BALLYBUNION APN: 762-330-014- - - Application description . . . POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 17000 Owner ------------------------ SOUTHERN HILLS DEVELOPMENT 55161 SOUTHERN HILLS LA QUINTA 9225 Contractor ------------------------ RIPARIAN ENVIRONMENTS V-:%. BOX 391106 CA -92539 9) 763-0645 JAN 112005 �1 STATE FUND C: 1769754 04/12/05 QUINTA CSL 839002 05/31/05 �ITY0 EOEpT. C8-C27-C297C53 PINAN Permit . . . . . . MECH POOL Additional desc . . Permit Fee . . . . 24.00 Issue Date . . . . Plan Check Fee . . 6.00 Valuation . . . . 0 Qty Unit Charge Per Extension . BASE FEE 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 45.00 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 Permit Fee . . . . 33.00 Plan Check Fee 8.25 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: r0� -771,(ZDate: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's 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 Code, and my License is jpiuyorce and effect. License Class �— License No. �3 06902- — Date i l —C) '� Contractor C p i" 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 itiucture, 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 ntl and Professions Code) or that he or she is exempt therefrom a,tfie 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; twill 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, thaj 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 burdan of proving that tie or she did not build or improve for the purpose of sale.). U 1, as owner of the property, am exclusively contrac`ing with licensed contdactors to*oons.truct 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/fdr M_1s-caasorJ Date ( 1 11 —0,: '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 main t in workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is [ is ed. Myworke compensation insurance carrier PAP01, b r Carrier S�O� e__ fLJU 0 Policy Number tdy Zn _ I certify that, in the performance of the work for which thl permit is issued, 10611 not employ 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 WA,RNING: 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 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 information is correi I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to ent the ve-mentioned property for inspection purposes. Date l 1 0 �— Signature (Applicant or Agent): Application Number . . . . Issue Date . . . . Page 2 04-00007714 Date 12/09/04 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 ONLY. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged ----------------- ---------- Permit Fee Total 282.00 Plan Check Total 142.50 Grand Total 424.50 Paid Credited Due ---------- ---------- ---------- .00 .00 282.00 .00 .00 142.50 .00 .00 424.50