05-1009 (RPL)T,Vf 4 4 Q"
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
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE AZ 85258
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
05-00001009 Date 3/21/05
81110 BARREL CACTUS RD
764-270-999-39 -300233-
POOL - RESIDENTIAL
MEDIUM HIGH DENSITY RES
6000
Contractor
------------------------
CALIFORNIA POOLS & SPAS
P.O. BOX 1280
COACHELLA CA 92236
(760) 398-9222
WCC: SEABRIGHT INS
WC: BB1050510 01/01/06
CSLB: 656128 10/31/06
CCC: C8 C27 C29 C53
--------------------- --------------------------------------------------------
Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Fee . . . . 15.00 Plan Check Fee 9.75
Issue Date Valuation . . . . 80
Qty Unit Charge Per Extension
BASE FEE 15.00
----------------------------------------------------------------------------
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 . . . . . . 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 . . . . 27.00 Plan Check Fee 6.75
P.O. BOX 1504�� VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFOPNIA�2253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: OS_ X00 7 Date: .0 -.?'1. 0 5 -
Applicant:
Applicant's Mailing Address:
C O"TRA C 7_0K
Architect or Engineer:
Architect or Engineer's Address:
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
C e, and my Lice a is i I force and effect. / J r7 p�
icense Class C— �� icense N h561 2,
D e &._ Contractor G
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 penally 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 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 workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
t r �) iss�ermy worlu s compensation ins rance car *25agd I'ic�nyr�r ber,Brg;/��
mer �t� I"u —PolicyNum r (D(
_ I certify that, in the performance of the work for 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 at, if should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall
/1^forthwith
comply with thosepr 'sion/s/./
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 Ouinta, 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 c ec . I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county enter upon abo e -mentioned property for inspection purposes.
fD tS e ? S� Signature (Applicant or Agent):
Page 2
Application Number . . . . . 05-00001009
Date 3/21/05
Issue Date . . . . Valuation'
0
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 6.0000 EA PLB FIXTURE
6.00
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 . .
. . 80
Qty Unit Charge Per
Extension
A BASE FEE
4-
15.00
: ----------------------------------------------------------------------------
Special Notes and Comments
'SPA ONLY. GAS/ELECTRIC STUB -FOR FUTURE
APPROVED APPLIANCE. 5 L.F. 4' BLOCK
WALL, CITY STANDARD. ALARMS/BARRIERS
SHALL BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid Credited-.
-----------------------------------------------
Due
----------
Permit Fee Total 126.00 .00 .00
126.00
Plan Check Total 33.75 .00 .00
33.75
Grand Total 159.75 .00 .00
159.75
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(4) AGREE THAT €AT•W3WA KXXS IS NOT RES-ON99LE FOR LT•@ RMOUW a1NINV liS #3 09,CCM
AND ANT ONAACC TO C3AK WEWAU(Ss DFOAVPAYSI LAMPIS- OR OTXER ITE1fs IH THE k+ AAEA
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vsE MATHOUT W IMN PQ W�" of fiJ+LFCtTMRA'POCU, ING IS i'F,0}}191TED BY Lot
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MAP BOOK PACE NO.
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MAIL ADDRESS
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SCALE
DATE
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Drainoge and irrigation for ptanters and pots. by
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