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04-6127 (RPL)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760)_777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFoRNiA 92253 INSPECTION REQUESTS (760).777-7153 BUILDING PERMIT Application Number . . . 04-00006127 Date 9/01/04 Property Address 81185 SHINNECOCK HILLS APN: 762-350-018- - Application description POOL - RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL Application valuation 17000 Owner 'CRV GOLF WEST C/O ALEX ZIKAKIa 9255 TOWNE CENTER DR 520 SAN DIEGO CA 92121 Contractor CALIFORNIA POOLS.& SPAS P.O. BOX 1280 COACHELLA CA 92236 (760) 398-9222 WCC:. • STATE FUND WC: 04600061168 01/.01/05 CSLB: 656128 10/31/04 CCC: "C8-C277C29=C53 Permit BLDG POOL PERMIT Additional desc . . Permit Fee . . 180.00 Plan Check Fee 117.00 Issue Date r. Valuation . . . . 17000 Qty Unit Charge Per Extension BASE FEE 45.00 15.00. 9.0000_THOU BLDG 2,001-25,000 135.00 ---------------------------------=------------------------------------------ Permit MECH POOL .Additional desc Permit Fee 24.00 Plan Check Fee 6.0'0 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE. <=100K 9.00 ----------------------------------------------- & -- U ------------------ Permit ELEC POOL PERMIT -RED Additional desc.. . Permit Fee 45.00 R n Check 3F��e�lt . 11..25 Issue Date aluation 0 CITY OF LA QUINTA Qty Unit Charge Per FINANCF-OEMExtension BASE FEE 15.00 P.O. BOX 1504 C&f 4 4 a*& 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT VOICE (760) 777-7012 FAX 760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: oa- (0/c2% Date: Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: AD �79 BUILDING PERMIT DECLARATIONS CENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed un r pro isions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Lice e is� force and effect. /License Class L ^ ,! i nse ._ J OWNER -BUILDER DECLARATION affirm I hereby arm under penalty of perjury that I am exempt from ontractors' 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 worts 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.). (--) 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 WORK ERS'_ 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 - rkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is iss d. yu��workers' ompensation' rancecari an cy• umber e: mer ""I�1� Policy Number n I certify that, in the performance of the work for whic his permit is ssued. I shall no employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, should be me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pr ' ions. zoC At WARNING: FAILURE TO SECURE WOR ERS' CO ENS ION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DO S (5100,000), 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.). Lendefs 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 a rees 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 ein -performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if is not mmenced 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 1 have read this application and state that the above information is sort I agree comply with all city and county ordinances and state laws relating to building construction, and hereby authorize re pre entatives of this courrt to enter up the ove-me toned property for inspection purposes. , Da/ to D Signature (Applicant or Agent . i Page 2 Application Number . . . . 04-00006127 Page 2 Application Number . . . . 04-00006127 Dsate 9/01/04 Qty Unit Charge Per .,Extension 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 Qty Unit Charge Per Extension BASE FEE 15.00 . 2.'00 6.0000 ,EA PLB FIXTURE 12.00 1.001*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 AT. PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT'INCLUDED Fee summary Charged Paid - Credited Due . Permit.Fee Total 282.00- :00 ..00 282.00• Plan Check .Total 142.50 .00 .0.0 142.50 Grand Total 424.50 .00 .00 424.50