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04-4799 (RPL)i BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760),777-7012 78-495 CALLE TAMPICO `. FAX (760) 7 77-701 1 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (76.0) 777-7153 Q a BUILDING PERMIT Appli io QAA ^04-660Q04-7-9=9--- Date ' 6/07/04 Prope Address -81050 SHINNECOCK HILLS APN: CITY OFIA,ijutNTA .162-330-005-5 -29147 - Appli at' I - 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 15.00 9.0000 THOU BLDG 2,'001-25,000 135.00 ---------------------------------------------------------------------------- Permit . . . . . . MECH POOL Additional desc Permit Fee . . . 24.00 P1an.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 r 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'POO1, 30.00 _ P.O. BOX 78-495 CALLELLE TAMPIt.O LA QUINTA, CALIFORNIA 92253 BUILDING 8 SAFETY DEPARTMENT Application Number: O - L - Applicant: I Architect or Engineer: -ppncani s maning Address: VOICE (760) 777.701: FAX (760) 777-701 i INSPECTIONS (760) 777-715? Date: rvcrntem or tngineer's Address: Lic. No. BUILDING PERMIT DECLARATIONS I hereby affirm under Penaltyof LICENSED CONTRACTOR'S DECLARATION penury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals ode, and my Lic rise i 11 force and effect. License Class C'_ License No. gsoc / Date —'7 (� � rn I hereby affirm under penaltyof OWNER -BUILDER DECLARATION perjury that I am exempt from the Contractors' State License Law for the followigg 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 Business U 1, as ss and Professions Code: The Contractors' State Licenof the properly, or my employees with wages as then sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, himself or herself or through his or her own employees. providse Law does not apply to an owner of property who builds or improves thereon• and who does the work ed 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 exclusiyely 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.). ( j I am exempt under Sec. , B.6 P.C. for this reason Date Owner I hereby affirm under penaltyof WORKERS' COMPENSATION DECLARATION 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 performance of the work for whic�hj this permit is issued. I ha and will main' it workers' compensation insurance• as required by Section 3700 of the Labor Code• for the performance of the work for which this permit is m ued. ,{wFy worke compensation i rice cartier�rid,poli artier( CQ(J� olicvNumberssued t: _ I certify that In the performance of the work for whit this compensation laws of California, and agree that. 1 shopuled Ibeco t is Ire subject tolthe twoRkers' Compensation provis ons o S_..ploy any person in any manner so aections to b37o0me biect of tfsu ppr ode�l sfRiell forthwith comply with those pro ' ns. Date "f� �plicent WARNING: FAILURE TO SECURE WORKERS' C NSATION 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. CONI hereby affirm under penalty of perjury that there is a construction lending agen T1for the LENDING AGENCY of he work for which this 9 permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's 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 a 1. Each person upon whose behalf this application is made, eachquest application. issued as a result of this application, the owner, and the applicant each agrees to, and shall. defendand for s ndbemnity and hold hart work is mless under City of La ui to any 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 100 days from date of issuance ryL uance of such peor cessation of work for 180 days will subject permit to cancellation. I certify that 1 have read this applicator; and state that the above info is correct. I agree to Comply with all city and county ordinances and state laws relating to building construction, and hereby authorize represe tatives of this county t ant upon the bove-mentionedrp ?_0 p party for inspection purposes. /Date _ 7 _ 0 / gnature (Applicant or Agent): Page 2. Application Number 04-00004799 Date. 6/07/04 --------------------7------------------------------------------------------- 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 ---------- 282.00 Plan Check Total 142.50 .00 .00 142.50 Grand Total 424.50 .00 00 424.50