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05-1611 (RPL)C�41OFTk�9 , ar c, nnllWGlVI (760).777-7-012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number 05-00QO1611 Date 4/27/05 Property Address . . . . 81150 SHINNECOCK HILLS APN: 762-340-007- - - Application description POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation 18000 Owner Contractor --------------------------------- SOUTHERN HILLS DEVELOPMENT --------------------------------- RIPARIAN ENVIRONMENTS 55161 SOUTHERN HILLS WCC: STATE FUND LA QUINTA, CA 92253 WC: 1769754-2005 05/01/06 CSLB: 839002 05/31:/05 ---------------------------------------------------------------------------- CCC: C8-C27-C29-053 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: (o Applicant: Applicant's Mailing Address: Date: 4-.110105* -.1g10s Architect or Engineer: Architect or Engineer's Address: Lic. No.: /V/A BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provision I Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals /lode, and my License is in full ff a and effect. / f, ✓ License Class AL N 6 C S 1 License No. Ci��Dd tgteT U-5 Contractor !�h(ty Z2 tq, OWNER43UILDER 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 cf the Contractors' State License Law (Chapter 9 (commencing with Section 70.00) 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 dol'ars ($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 ,icensed 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. 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 Sa issped. Ju{y workers' compensation insurance terrier policy number are: VIC arrier ( ar }moi t xAA Policy Numbe- ti� S q 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 provisions. (� Applicant 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 A/ 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 correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this co y to enter upon the above-mentioned property for inspection purposes. DSte `[. C� Signature (Applicant or Agent): %�/( ---------------------------------------------------------------------------- L Application Number . . . 05-.00001611 ------------------------------------------------- -------------------------- Permit . . . . . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 189.00 Plan Check Fee 122.85 Issue Date Valuation . . . . 18000 Expiration Date 10/24/05 Qty Unit Charge Per Extension BASE FEE 45.00 16.00 9.0000 -------------------7-------------------------------------------------------- THOU BLDG 2,001-25,000 144.00 Permit ... . . . . MECH POOL Additional desc Permit Fee 24.00 Plan Check Fee 6.00 Issue Date . . Valuation . . . . 0 Expiration Date 10/24/05 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 Expiration Date 10/24/05 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 Issue Date . . . . Valuation . . . . 0 Expiration Date 10/24/05 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 -----------7---------------------------------------------------------------- EA PLB GAS PIPE 1-4 OUTLETS 3.00 Special Notes and Comments POOL & SPA ONLY. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PRE -PLASTER m .INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged ----------------- ---------- Permit Fee Total 291.00 Plan Check Total 148.35 Grand Total 439.35 Paid Credited Due ---------- ---------- ---------- .00 .00 291.00 .00 .00 148.35 .00 .00 439.35 Bin # Permit # Project Address: p( A. P. Number: City of La Quinta Building 8l• Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet O p Ll �SOwner's Name: Sv�J( r cue 1kJ M. l 1 l CJ (r Address: • (S��t `� "� o City, ST, Zip: ✓(•n k.� T Contractor: L?A0 FAAAWPKE Telephone: - Address: PO Z L?Y, L S 9 -LO Project Descriptionaft, v r..�•.� Construction Type: Occupancy: . c P an cy P State Ltc. #: Pr oJ e ct type (circle one): Add' n Alter Repair Demo Name of Contact Person: A'R Sq. Ft.: # Stories: # ts: Telephone # of Contact Person: S , -41S SI Estimated Value of Project: f8 IPOO APPLICANT: DO NOT WRITE BELOW THIS LINE q Submittal —7 Req'd Rec'd TRACKING PERMIT FEES Plan sets I Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Plan Check Balance Truss Calcs. Called Contact Person Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.l•I.I. ILO -A. Approval Plans resubmitted Grading Developer Impact Fee A.I.P.I'. IN IIOUSE:- '"' Review, ready for corrections/issue Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees