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04-4796 (RPL)I BOX 1504 ?5 CALLE TAMPICO UINTA, CALIFORNIA. 92253 BUILDING PERMIT Application Number . . . . . Property Address . . . . APN: Application description . . . .Property Zoning . . . . . . . .Application valuation . . . . BUILDING & SAFETY DEPARTMENT s_ (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Date 6/07/04 81020 SHINNECOCK HILLS .762-330-002-2 -29147 - POOL,- RESIDENTIAL LOW DENSITY RESIDENTIAL 17000 Owner Contractor SOUTHERN HILLS DEVELOPMENT RIPARIAN ENVIRONMENTS SOUTHERN HILLS P.O. BOX 391106 _-55161 s - LA QUINTA CA 92253 ANZA CA 92539 (50 9) 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 ChargePer Extension BASE FEE 45.00' 15.00 9.0000 THOU BLDG 2,001-25,000 „135.100 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 _ 78-495 CALLE LL$ TAMPICD LA QUINTA, CALIFORNIA 92253 BUILDING 8 SAFETY DEPARTMENT Application Number: 4{ - 4,7q( Applicant: rappncani s mailing Address: Architect or Engineer: VOICE (760) 777.701; FAX (760) 777-701 : INSPECTIONS (760) 777-7153 Date: r;1 Architect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS I hereby affirm under penaltyof LICENSED CONTRACTOR'S DECLARATION 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 Lip rise is in full force and effect. /License Class2 cense No. J __Date -'�y� or-��r �j� /1�U 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 the permit to file a signeo 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 1, as ownei 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 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 pmject.(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 which this permit is issued. I have andwill ntain workers' compensation insuranceas required by Section 3700 of the Labor Code• for the Performance of the work for which this ued- My *ers' compensation i�� cue carrierp d 0'' r are: permit is ef ! of/� icy Number /� Y'yr _ I certify that, in the performance of the work for which this permit is issued. I shall not employ any person in any mannerso as to become subject to the workers' forthwith comply with those provisi9P&- n ' compensation provisions of Section 3700 0} the Labor Cods, I shall compensation laws of California, and agree that, if 1 should become subject to the workersi WARNING: FAILURE TO SECURE WORKERS COfk ENSATION 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 consWction lending agency CONSTRUCTION NDINGPerforha AGENCY oCthe 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 Building AP Safety AaCKNOWLEDGEMENT 1. Each permit 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 rtomhed under or pursuant to an 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 sit officers, agents and employees for any act or omission related to the work being performLa Quirtta, its 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 permita construction, and hereby authorize representatives of t 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 p0 r 1 agree to comply with all city and county ordinances and state laws relating to buildinA his county to er upon the rove•mentionedro p perty for inspection purposes. ,0ate �-D Si nature t / 9 (Applicant or Agent): u n Page 2 Application Number . . . . . 04-000047'9.6 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 u n