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04-5786 (RPL)A BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICo FAX (760) 777-7011 ` LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777 -7153 - BUILDING PERMIT Application Number Property Address . 0'4-0 0 0 86 Da�t.e 7_/30/04 . . . X60612 SI EVL R TORCH FIR A APN: 764-270-999-72-30�2�3- Application description . . . POOL - RESIDENTIAL�� Property Zoning MEDIUM, HIGH DENSITY Rp S ,-.0 3 0.5 2604 ' Application valuation 17000 CITY ®FL4 QUINTA Owner FINANCE Contractor . DEPT: ------=----------------- SHEA LA QUINTA CALIFORNIA POOLS & SPAS C/O JEFF MCQUEEN P.O. BOX 1280 8800,N GAINEY CENTER 350 COACHELLA CA 92236 SCOTTSDALE AZ 85258. (760). 398-9222 WCC: STATE FUND WC: 04600061168 01/01/05 CSLB: 656128 10/31/04 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 Charge Per Extension BASE FEE 45.00 15.00 9.0000 THOU, BLDG'2,0'01-25,000 135.00 Permit ME CH 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 9.0) ----------------------------------------------------------- Permit . . . . ------------------ ELEC POOL PERMIT -RES Additional desc Permit Fee 45.00 Plan Check Fee 11.25 Issue Date . . . . Valuation ) Qty Unit Charge Per Extension BASE FEE 15.0) P.O. Box 1504 Y A. 78-495 CALLE TAMPICO VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 a" FAX (760) 77777011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 04- 5% 8 Date: Applicant: I Architect or Engineer: Appncant-s Mailing Address: Arcnitect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS &underovisio D CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed s of Chapter 9 (commencing with Section 7010 of Division 3 of the Business and Professionals C ,andmyLicefeis) II force and effect.censeClass ( J C�7 rl __,--6a5T/_I_C_ontractor_A,,, \ gWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from th tractors' 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, 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 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 penalty of perjury one of the following dec arraattiiionsRS' COMPENSATION DECLARATION 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 t is permit is issued. /I have and will maintai orkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is _ iS/rd. y work compensationmance carri IicM�umber re: er d`li�C Policy Number U ( G _ I certify that. in the performance of the work for which hi ermi is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if ould b come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall (�(y forthwith comply with those pr isions. f� -- - • WARNING: FAILURE TO SECURE WORWbS' COMPENSATi6s 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 herebyaffirm under CONSTRUCTION LENDING AGENCY penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address >� IMPORTANT Application is hereby made to the Director of Buildingand Safety for CKNOWLEDGEMENT T A 1. Each person upon whose behalf this application is made, each person at whose request a and wholse benefit work isons and nperformed under or pursus set forth on this e t to any permit issued as a result of this application, the owner, and the applicant, each agre s to, and shall, defend, indemnity and hold harmless the City of La Ouinta, its officers, agents and employees for any actor omission related to the work b m o ed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if wo not ce len 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 inf ation is co I agree t mply with all city and county ordinances and state laws relating to building construction,Pnd h reby authorize representatives of this county ter upon a ov oned property for inspection purposes. ate r�d Signature g ature (Applicant or Agent): r Page 2 Application Number 04-0000578'6 Date 7/30/04 Qty Unit Charge Per Extension 1.00 30.0000 ---------------------------------------------------------------------------- EA, ELEC PRIVATE SWIMMING POOL' 30.00 Permit . . . . . PLUMBING Additional desc Permit Fee . . . . 33.00 Plan Check Fee .8.2.5 '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,GAS STUB FOR FUTURE APPLIANCE ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION.. EQUIPMENT ENCLOSURE NOT INCLUDED ` Fee summary Charged. ----------------- Paid Credited Due a ---------- Permit Fee Total ----------------=--- 282.0.0 .00 .00 ---------- 282.00 Plan Check Total 142.50 .00 .00 1'42.50 Grand Total 424.50 .00 .00 424:50