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04-7707 (RPL)-Tihf 4 4 a" P.O. Box 1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777=7012 FAX.(760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . C . . . ." 04-00007707 Date 12/09/04 Property Address . . . . . . 57665 BALLYBUNION APN: 762-360-015- - - Application description . . . POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation 17000 Owner Contractor ------------------------ ------------------------ SOUTHERN HILLS DEVE T RIPARIAN ENVIRONMENTS 55161 SOUTHERN H S P.O. BOX 391106 LA QUINTA CA 92JI31ttS ANZA CA -92539 �AN (909) 763-0645 D : STATE FUND �'nP?A WCC 1769754 04/12/05 G1NCE� .F NACSLB: 839002 05/31/05 CCC: 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 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: a -7 Date: it:-) b -o s Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: it// 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) ofDivision 3 of the Business and Professionals Code, and my Li se i II force and effect. License Class— Li nse No C Date—/—'// � J Contractor OWNER -BUILDER DECLARATION'_��" I hereby affirm under penalty of perjury that I am exempt from the Contraciors' 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 Licerise,•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 exemptiori''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).): f 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 noi:apply to an,o°yJner 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`hot 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. , B.8 P.C. for this reason 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 will maintain w ers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is /rssu�d. Myers' co pensation insurance carrier ar�,p is u b e ,Carrier �1C.t.'tQ T c)W Policy Number 1 7' ;,m _ I certify 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, 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 provision Date Applicant � / / WARNING: FAILURE TO SECURE WORKERS' COMPEN ION CO ERAGE 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 informati is cor . I agree o comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to er upo the bove-me Toned property for inspection purposes. -,Date �' —� Signature (Applicant or Agent): e Page 2 Application Number . . . . . 04-00007707 Date 12/09/04 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 ----------------------------------------------------------------------------- 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 Paid Credited Due Permit Fee ---------- Total ---------- 282.00 ---------- .00 .00 ---------- 282.00 Plan Check Total 142.50 .00 .00 142.50 Grand Total 424.5.0 .00 .00 424.50 e