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05-1224 (RPL)BUILDING & SAFETY DEPARTMENT O. Box 1504 (760).777-7012 8-495 CALLE TAMPICO FAX (760) 777-7011 A QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)..777-7153 umber . . . ess . . . tirN Application description Property Zoning . . . . . Application valuation BUILDING PERMIT 05-00001224 Date 4/01/05 81100 SHINNECOCK HILLS 762-340-002- - - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 17000 Owner Contractor SOUTHERN HILLS DEVELOPMENT RIPARIAN ENVIRONMENTS 551.61 SOUTHERN HILLS P.O. BOX 391106 LA QUINTA CA 92253 ANZA CA 92539 (909) 763-0645 WCC: STATE FUND WC: 1769754 04/12/05 CSLB: 839002 05/31/05 CCC: C8-C27-C29=C53' ---------------------------------------------------- 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 21,001-25,000 135.00 ----------------------------------------------------- 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 . ... . . . 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 430.00 ---------------------------------------------------------------------------- Permit .. . . PLUMBING Additional desc Permit Fee 33.00 Plan Check Fee 8.2.5 P.O. Box 1504 • 4 �� VOICE (760) 777-7012 78-495 CALLS O FAX (760) 777-7011 LA QUINTA, CALIFORNIAFOR 922534 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number:! T2- 2/ I Date: _41—S—D.S Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: 'BUILDING PERMIT DECLARATIONS - LICENSED CONTRACTOR'S DECLARATION I h�gJ�e rby 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 J i! 06de. and my License is in full force and effect. / License ClassLicense No. ✓ � 00r r. f) ate ii D J Contractor✓ OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the folfowing reason (S.ec.17031.5, 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 thei permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (comritencing 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 rive 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 hot intendii i 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 thereori,'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 ownyf 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 contractors) licensed pursuant to —the Contractors' State License Law.). U 1 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: 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 J, 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 ssu d. Myworkers' compensation insurance carried policy nb um mer \� Gr-{'✓/�✓1 Policy Number✓ I 1% 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. Q�t�6 4 o) Applicantf/ �71Wq 1 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 it 1A 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 county to enter upon the above-mentioned property for inspection purposes. ate LI O �) Signature (Applicant or Age ttS ): Page 2 Nu 05-00001224 Application um Date 4/01/05 Issue Date..., Valuation 0 Qty Unit Charge Per " Ext.ension 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 3.0.000 EA .. PLB.-GAS PIPE 1=4 OUTLETS 3.00 Specia-1 Notes. and Comments v-' '-,- -,- POOLBE IN POOL & SPA.-ALARMS/BARRIERS-SHALL ..,,.,,.PLACE PRIOR TO PRE -PLASTER -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