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04-4797 (RPL)t O s BUILDING & SAFETY DEPARTMENT P.O. Box 1504 ® (760).777-7012 e 78-49 ALLE TAMPICo FAX (760) 777-7011 TA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 JUN 0 3 2004 BUILDING PERMIT' pp kation u = . . . . . 0A4=0_00.04797 Date 6/07/04 Property Address . . ... 81030-SHINNECOCK HILLS APN: .762-330-003-3 -29147 - Application description POOL - RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL Applicati.on 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 --------------------7------------------------------------------------------- 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 30.00 P.O. BOX 1504 7$-495 CALLE TAMPI[D LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: 0 - 4� Applicant: P%ppnt:ani s mailing Address: Architect or Engineer: VOICE (760) 777-701: FAX (760) 777.701 ; INSPECTIONS (760) 777-715: Date: G g - ^16111teG1 or cnglneer•s Address:. Lic. No.. BUILDING PERMIT DECLARATIONS I hereby affirm under penaltyof 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 Lice se is in full force and effect. (► /License Class_ � �2� se No 1? 9010 % i /Dateonn tractor �t ()2t(� l Ol 1� CSA i)t f`OVIYVIpI J�� 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 of the 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 1, 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 t 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.). (--) 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 contractors) licensed pursuant to the Contractors' State License Law.). U 1 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, fort performance of the work for which this permit is issued. I 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 ued. work ' compensation in��su�r'' nc�e came4a�� p y r /Carrier C�tIVlO oltcyNumber l^f[�o \ �l re I certify that, in the performance of the work for which this permit isissued. I shall not employ an y _ t, if I should become subject tot workers' compensation provisions S ons o to of t Labor ode, I shall compensation laws of California, and agree t forthwith comply with those prow lo s. cant WARNING: FAILURE TO SECURE WORKER '-COM NSA ION 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 is a construction lending agen y ffoor the performa nce uC he work for which this 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 application. 1 • Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under a 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 har ned the City u s Ouitoa, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this 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 i permit. permit. of such pemti! 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 e r u Nt bove-mentioned Property for inspection purposes. ate • nature (Applicant or Agent): Page 2 Application Number . . . . . 04-00004797 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 .00 282.00 Plan Check Total .142.50 .00 .00 142.50 Grand Total 424.50 .00 .00 424.50