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04-4363 (RPL)Titr 4 4 Q" 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 Property Address APN: Application description . . . Property Zoning Application valuation Owner ------------------------ ASHBROOK 5140 AVE. ENCNITAS LA QUINTA CA 92253 04-00004363 Date 5/21/04 81165 SHINNECOCK HILLS 762-350-016-27 -29147 - POOL — RESIDENTIAL LOW DENSITY RESIDENTIAL 22000 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 -C27 -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 des.c Permit Fee . . . . 225.00 Plan Check Fee 146.25. Issue Date . . . . Valuation . . . 22000 Qty Unit Charge Per. Extension BASE FEE 45.00 20.00 9.0000 THOU BLDG 21001--25,000 180.00 ---------------------------------------------------------------------------- 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 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 Application Number: Applicant: • .. Address BUILDING & SAFETY DEPARTMENT Date: Architect or Engineer: & i / A Architect or En Lic. No.. t3UILUINU 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 License iinorce and effect. �!� License Class License No. d Date Contractor O ER43UILDER' DECLARATION 1 hereby affirm under penalty of perjury that 1 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 stricture, 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 1, 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: _ 1 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 perfornance 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 �ss ed.,My work9compensation insurance carrier and li�q raft ` / Cartier—�> ¢-rf,�,y�ss� Policy Number___ -/) 0,11640 _ rceitify 'n 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, agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall 7forthwith comply with those pro ' io s. Date • f✓ Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENS ION 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 uhder 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 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. I. 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 correct. I agree to comply with all city and county ordinances and state taws relating to building construction, and hereby authorize representatives of this county nter upon the above-mentioned p party for inspection purposes. Date Signature (Applicant or Agent): Application Number 04-00004363 Page 2 Date 5/21/04 Qty Unit Charge Per Extension 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL : 30.00 --------------------------------------------- . . . . . . 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 1.00 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 . . . . 21:00 Plan Check Fee .00 Issue Date Valuation 758 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 2.0000 HND BLDG 501-2,000 ---------- - 6.00 -------------------------------------- ------------------- Special Notes and Comments ---------- POOL & SPA. BBQ ANSI Z21-58-1995. FIREPIT 496AGAL..35 LF 5' BLOCKWALL. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. - Fee summary Charged Paid Credited ----------------- Due ---------------------------------=------ Permit Fee Total 348.00 :00 .00 348.00 Plan Check Total 171.75 .00 .00 171.75 Grand Total 519.75 .00 .00 519.75. YOUNG ENGINEERING -SER VICES • Engineering -• Architecture -Surveying- Building & Safety Services .Letter of Transmittal To: City of La Quinta Date: 5/20/04 Project. 81-165 Shinnecock Hills Attn: Ed Randall PC#: PC# 04-4363 (ls` Check) Tel No.: (760) 777-7012 Tract No.: We are forwarding: X By Messenger By Mail Your Pickup No. of Copies Description: 1 Plans 1 Calcs Comments: Plans are approvable. Thanks This Material Sentfor: Your Files Per Your Request Your Review z Approval Checking At the request of: Other By: Eric Frenzel Phone # 760-360-5770 77-804 Wildcat Drive, Suite C, Palm Desert, CA 92211 (760) 360-5770 Bronz Young