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04-4800 (RPL)a� BUILDING & SAFETY DEPARTMENT w� BOX 1504 (760).777-70.12 95 CALLE TAMPICO FAX (760) 777-7011 OV�Nrp, LA UINTA,' CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 C�� O NC D��• FNP BUILDING PERMIT- Application Number .. . . . . `"04=00004800__`, Date.,,'. 6/07/04 Property Address . . . . . �-8-1-0-60__ SHINNECOCK HILLS APN: .762-330-006-6 -29147 - Application description . . . POOL - RESIDENTIAL .Property Zoning . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 17000 Owner Contractor ------------------------ ------------------------ SOUTHERN HILLS DEVELOPMENT RIPARIAN ENVIRONMENTS .55161 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 -C2-9-053 ----------------------------------------------------------------------------- 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 1'5.00 9.0000 'THOU . BLDG 2,•00.1-25, 000 13.5.00 --------------------------- ----------- - ------------ ------- ------- Permit' MECH POOL Additional dest 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 r 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 30.00 '.4 P.O. BOX 1504 78-49$ CALLE TAMPIt.D � VOICE (760) 7', 7-701: LA QUINTA, CALIFORNIA 92253 FAX (760) 777_701: INSPECTIONS (760) 771.7153- BUILDING 77.715?BUILDING & SAFETY DEPARTMENT Application Number: oZ4- 00 _ Date: e5 Applicant: Architect or Engineer: fr Applicant's Mailing Address:Architect or Engineer's Address: r Lic. No. BUILDING PERMIT DECLARATIONS I hereby affirm under penaltyof LICENSED CONTRACTOR'S DECLARATION pequry that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals and my, License is in I force and effect. c License Class�� `j License No. _ /} 306 Date 26 /contractor tv-I r^. r Cf • I, v'w.r. IA. A. § n I hereby affirm under penaltyof OWNER -BUILDER DECLARATION 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 thepermit 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 ,s 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 hereby affirm under penaltyof WORKERS' COMPENSATION DECLARATION 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 whichLhirmit is issued.I have and will maintais' compensation insurance,as required by Section 3700 of the Labor Code, for the rformance of the work for which thisi u orkersnsation in�ance came�permit r permit is Carrier t,! o�1s licy Number . certify that, in the performance of the work for which ued, I shall not employ any person in any manner so as to become subject to the woAcers' compensation laws of California, and a that, i I subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shell forthwith comply with those provisS.f —;21-0 WARNING: FAILURE TO SECURE WORKERS' COMPVSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (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. I hereby affirm under penalty of perjury that there is a construction lending agency CONSTRUCTION LENDING PerforAGENCY Goa oCthe work for which this permit is issued (Sec. 3097, Civ. C.). Lenders Name Lenders Address IMPORTANT APPLICANT ACKNOWLEDGEMENT 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, indemnity and hold harmless the City of La OuiMa, 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 on 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 ent r pon above-mentionedro P Petty for inspection purposes. ure (Applicant or Agent): Page, 2 Application Number . . . . . 04700004800 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 •P.LACE-AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee -summary Charged Paid Credited Due,. Permit Fee Total 282:00 .00 .0.0 282.00 Plan Check Total 142.50 .00 .00 142.50 Grand Total 424.50 00 .00 424.50