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04-7406 (RPL)T__df 4 4� a" BUILDING & SAFETY DEPARTMENT Ox 1504 (760),777-7012 CALLE TAMPICO• FAX (760) 777-7011 INTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT �App1`=tion Number . . . . Property Address . . . . . APN: Application description Property Zoning . . . . . . Application valuation . . . Owner 04-00007406 Date_ 11/22/04 .`"-'49570 RANCHO LASS MARIPOSAS 649-620-042-69 -28964 - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 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 10/31/06 CCC: C87C27-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 P.O. Box 1504 • ��' 78-495 CALLE TAMPICO � VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 4 4 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING &[ SAFETY DEPARTMENT Application Number: (110 Applicant: Architect or Enginee rA-te: Applicant's Mailing Address: 1)4 /T itect or Engi 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 Licen d`is inIalt'�rce and effect. / Q� License Class �� J J Pse No. Datel// 40,1 Contractor 11 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempVIrDaAe 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 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 contract g with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner erty 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 amexempt under Sec. , B. P.C. fo is reaso /43 Date G G % Owner I \ \ WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the g 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 maint ,n 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 A work 'compensation insurance c n gqgqcyy��yy�(nnbb��r �Ie: Cartier s K Policy Nu er foCiC7CJ _ 1 certify that, in the performance of the work fo ich this emit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agr a t, if I sho Id become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwit comply with those pr isions. Date 6 Applicant WARNING: FAILURE TO SECURE WO ERS' CO S 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 perl'ury 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, an 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 bei orme under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if wo s of comm ced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit td cancellation. 1 certify that I have read this application and state that the above information is co ct. I gree to ply with all city and county ordinances and state laws relafing to building constru"OF horize representatives of this county to ter upon , ab v -menti d property for inspection purposes. Datel/Signature (Applicant or Agent): Page 2 Application.NumbQr . . . . . 04-00007406 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 ----------------------------------------------------------- Special Notes ------------------ and Comments POOL & SPA. 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 424,50 .00 .00 424.50 �I