04-4798 (RPL)O O
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504
(760).777-7012
OFTt�'� 78- ALLE TAMPICO i r 1 a FAX (760) 777-7011
D e� �.LA Q TA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
JUN 0 8 2004 BUILDING PERMIT F
\,
CITY OF ! A QUINTA
pplic � mb04_=-0_-00-0,47DAte� ,6/07/04.
oper y Address . . . . . . 81040 SHINNECOCK HILLS
APN: .762-330-004-4 •-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
l
CCC: C8 -C27 -C2,9-053
---------------
. . 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 ti 45.00
15.00 9:0000 THOU. BLDG 2,001-25,0'00 135.00
. ----------------------------------------.------------------------------------
Permit . . . MECH POOL
Additional desc
Permit Fee 24.00 Plan•Check Fee �. -6..00
Issue Date Valuation 0
Oty Unit Charge Per Extension
BASE. FEE 15.00
1.00 9.0000 EA MECH FURNACE <=100K 9.00
-------------------------------------------------7-------------------7------
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, 30.00
w
P.O. BOX 1504 Tait
'��
78-495 CALL$ TAMPICO � VOICE (760) 777-701;
LA QUINTA, CALIFORNIA 92253 44FAX (760) 771-701 :
BUILDING & SAFETY DEPARTMENT . INSPECTIONS (760) 777-7153
Application Number: 6q- 41 Q s Date:
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address: '
Lic. No.
BUILDING PERMIT DECLARATIONS
I hereby affirm under penallyof LICENSED CONTRACTOR'S DECLARATION
perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
/ Code, and my Ucensp -S NII'force and effect.' sr)
License Class _('-� License No._B &Q
Date — 'iD ' Contractort
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of 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 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, antl who does the worts
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 ms
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. build Business and Professions Code: The Contractors'
State License Law does not apply .) an owner of property who builds or improves Mereon, 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:
_ 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
_4of the work for which this permit is issued.
I have and will main t in workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this
uedki io work 'compensation insurance camel �ad,00linrau permit is
011ty Number
_ I certify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any manner so as to become. Subject to ffine workers'
compensation laws o1 Califomia, and a e that, if should become subject to the workers' compensation provisions of Section 3700 o} the Labor Code, 1 ers,
forthwith comply with those provision.
WARNING: FAILURE TO SECURE WORKERS' COMPVS)SATION 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.
I hereby affirm under penalty of perjury that there isa construction lending TRUCT agency for LENDING
PerforAGENCY
oC
Lenders Name the work for which this
Permit is issued (Sec. 3097, Civ. C.).
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.
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the
I. Each Person upon whose behalf this applicaticn is made, each person at whose request and for whose benefit work is performed under or pursuant to any Perrtlil
City of s OtriMa, 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 100 daytb from date of issuance of such pennil of
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this applicatiori 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 en n above-mentioned property for inspection purposes.
S e (Applicant or Agent):
Page 2
Application Number . . . . . 04-0000479.8 1
Date 6/07/04
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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
1.010 3.000,0 EA PLB GAS PIPE 1-4 OUTLETS
3.00
--------------------------------------------=-------------------------------
Special Notes and Comments
j 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 2`82.00. .00 '00
282.00`
Plan Check Total. 142.50 .00 .00
1,42.50
Grand Total 424.50 .00 .00
4,24.150