04-4393 (RPL)BUILDING & SAFETY. DEPARTMENT
P.O. Box 1504(760)777=7012.
KOFJ'
T1�9 78-495 CALLE TAMPICO FAX
(760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS. (760) 777-7153 '
BUILDING PERMIT ..
Application Number
---=04--00"0043_-9.3i"'�
Date 5/18/04
.Property Address .
. . .`— 6RO0702 OURKE CIR
APN:
764-.27.0-999-11 -300231-
Application description
POOL - RESIDENTIAL
Property Zoning
MEDIUM HIGH DENSITY RES
AppLicat an.valuation.
15.000
Owner.
Contractor .
SHEA'LA QUINTA
CALIFORNIA POOLS
& SPAS
C/O JEFF MCQUEEN
P.O. BOX 1280
88.00.;N.GAINEY CENTER
35;0..:. COACHELLA
CA 92236
S.COTTSDALE
AZ 85258 (760)% 398-.9222
WCC:. STATE FUND
WC:. 04600.0'.61168
.' 01/01/05
CSLB::' .656128
10/31/04
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 Chargee
Per
Extension
BASE FEE'
15 . 00
1.00 9.0000
EA MECH.'FURNACE <=100K.
9.00
:. Permit'.BLDG
----------------------
POOL PERMIT
Additional- desc ..
Permit Fee:
162.00. :.Plan Check Fee
-105.3.0
Issue Date.Valuation
15.000
Qty Unit Charge
Per.
Extension
BASE. FEE.'45.'00
1.3..00 9.0000
THOU :'BLDG 2-, 001=25•,'000
117 .'00.
Permit
ELEC POOL PERMIT -RES.
------------
Additional desc
Permit Fee
45: 00 ..' Plan Check Fee.
11.25.
Issue Date
Valuation
0
Qty Unit': Change:
.,Per ;.
Extension'
BASE FEE
15.00
P.O. BOX 1504 a
4,4
VOICE (760) 777-7012
78-495 CALLE TAMPICOFAX (760) 777-7011
LA Qu[NrA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
v
Date:
Architect or Engineer. Ij
Architect or Engineer'sr
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 Lice nsg is In full force and effect ` !� `2 r1
License Class L-= $ 3 License No. & 0
Date � f 9� Contractor `
OWNER43UILDER DECLARATION
1 hereby affirm under penalty of perjury that 1 am exempt from the Contradors' State License Law for the following reason (Sea 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 Co4e) 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 pemmt subjects
the applicant to a civil penalty of not more than five hundred dollars (=500).),
U 1, 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 (Sea 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and win does the work
himself or herself or through his or her own employees, provided that the Improvements are not intended or offered for sale. It, however, the building or improvement Is
sold within one year of completion, to owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sea 7044, Business and Professions Code: The Contractors'
State License Law does not appy 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 1 am exempt under Sea . BA PSC. 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 self4nsurefor 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
�yyssuu My wo rs' comgpensation.insurance carrier and pd' mbar are:
Carrier _4 f,Q P- 4flAA, 14 Policy Number a422 // e
I certify that, in the performance of to work for which tris 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, l shall
forthwith
� comply with those provis ns.
Date �/ Applicant
WARNING: FAILURE TO SECURE WORKERS' COAQPENSATION 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
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 (Sea 3097, Civ. C.).
Lenders Name
Lenders 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 Quanta, 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.
1 certify that 1 have read this application and state that the above info on is correct. 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 r porn the aboveansn' for Inspectionpurposes.
ProPeRY P
'
Date Signature (Applicant or Agent):
Page 2
Application Number
. . . . 04-00004393
Date 5/18/04
Qty Unit Charge
Per
Extension
1.00 30.0000
EA ELEC PRIVATE SWIMMING POOL
30.00
Permit" . . .
PLUMBING
Additional, desc
Permit Fee . ...
27.00 Plan Check Fee'.
6.75
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
Special Notes and Comments
POOL ONLY..ALARM BARRIERS
SHALL BE IN
PLACE PRIOR TO PREPLASTER
INSPECTION..
Fee summary Charged Paid Credited
Due
-Permit Fee Total
258.00 .00 .00
258.00
Plan'Check Total
129.30 00 .00
129.30
Grand Total
387.30 00 .00
387.30
e