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04-4801 (RPL)i i w, f Tldr.*4 4V a" BUILDING & SAFETY. DEPARTMENT K 1504 (760).777-7012 :ALLE TAMPICo ' FAX (760) 777-7011 TA, CALIFORNIA 92253 INSPECTION REQUESTS (76 0.) 777-7153 Application Number . . . Property Address . . . . APN: Application description.. Property Zoning . . . . . Application valuation BUILDING PERMIT _Q4=0000480.1-} Date 6/07/04 81070 SHINNECOCK HILLS 762-330-007-7 -29147 - POOL - RESIDENTIAL LOW DENSITY RESIDENTIAL 17000 Owner Contractor. .SOUTHERN HILLS DEVELOPMENT RIPARIAN ENVIRONMENTS ..5.5161 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 -C29-053 ---------- --------------------------------------------------------------- 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 2;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 a 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 '3.0.00 P.O. Box 1504 _ 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Applicant: Applicant's Mailing Address: , r VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 Date: 6 .g ' 2� Architect or Engineer: rvcrnteci or tnglneer's Address: Lic. No.. t$UILUING PERMIT DECLARATIONS I herebyaffirm under LICENSED CONTRACTOR'S DECLARATION 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 a is in fuu torce and effect. License Class -S � cense No. Date —O o► �� /%tr(Gt,c ,61/(A� (rV V Y"A I hereby affirm under penaltyof OWNER -BUILDER DECLARATION perjury that I am exempt from the Contractors' State License Law fort 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 oft Business and Professions Code) or that he or she is exempt therefrom and the basis fort 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 said. 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 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 I herebyaffirm under WORKERS' COMPENSATION DECLARATION 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 performance of the work for which this permit is issued. ! ' I have and will maint in workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is i ued. wogs' compensation i nce camera p i a artier alicv Number _ I certify that, in the performance of the work for which tRis is 1 tis issued, I hall not employ an y person in any compensation laws of California, and agree that I should become subject to the workers' compensation provisionsmanner of aection 3377s to 0 of t subject Code. to the workers' shall forthwith Comply with those provi ns, / / WARNING: FAILURE TO SECURE WORKER-COMPVSATION 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 D SECTION 3706 OF THE LABOR CODE, INTEREST, ANATTORNEY'S FEES. ENCY I hereby affirm under penalty of perjury that there is a construction lending agency orlthe PerformanLENDING ce of the work for which this Permit is issued (Sec. 3097, Civ. C.). Lenders Name Lender's Address IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT aCKNOWLEDGEMENT 1. Each Safety Apermit subject to the conditions and restrictions set forth on this application. 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, indemnity and hold harmless the City of Ls Quints, 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 info o IS Co I agree to comply with all city and county ordinances and state laws retating to building construction, and hereby authorize representatives of this county to nter upon t ntioned property perty for inspection purposes. ,Baied i/5 nature 9 (Applicant or Agent): Page 2 Application,Number . . . . . 04-00004801 Date 6/07/04 ---------------------------------------------------------------------------- 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 1.00 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/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 28.2.00 Plan Check -Total 142.50 -.00 .00 .142.50 Grand Total ..424.50 .00 .00 424.50