04-3870 (RPL)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504
(760),777,7.012.
78-495 CALLE TAMPICO FAX (760) 7774011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . .
. . 04-00003870 - Date'
5/20/04
.Property Address . . . .
. 819'29_SUN--CACTUS LN
APN:
7647270. -999 -17 -300231 -
Application description
POOL --RESIDENTIAL
Property Zoning .
. . MEDIUM HIGH DENSITY RES
Application valuation'...
1700.0
Owner.
Contractor.
SHEA HOMES
CALIFORNTA POOLS & SPAS
P.O. BOX 1280
"., 812 6 0 AVENUE . 6 2
r COACHELLA CA
9 2 2 3 6.
LA QUTNTA CA 92253-
(760) 398-9222 .
'(909')--- 833-8996
WCC: STATE FUND
WC: 0460.006.1168:
.01/01/05
'CSLB.: 65.6128° ..
10/31/04
CCC: C87C27.-C29=C53
-
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 BLDG
----------------------------
POOL.PERMIT
Additional desc.. .
.Permit Fee. 189.00.
Plan :Check Fee
-122.85
Issue Date
Valuation,
18000
Qty Unit Charge Per
Extension
BASE . FEE
45-.,00
.16.00' 9. 0000 THOU:
BLDG 2,`001-25'1 000
144.'..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
P.O. Box 1504
78-495 CALLE TAMPiCO
LA QUiNTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Architect or
Architect or
Lic. No.: "
VOICE (760) 777-7012
: FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of 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 Licar►sg is in full force and effect fz
License Class L� 53 License No.
Date0,1`Contractor `
OWNER43UILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.6, Business and Professions Code: Any
city or county that requires a permit to construct, alter. improve, demolish, or repair any structure. prior to its Issuanoe. 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 ) or.fhat 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 owner of the property, or my employees with wages as their sole cormmpensation, will do the work, and the structure is not intended or offered for sale (Sea 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 ori mprovemant is
sold wittiin 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 (Sea 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 PSC. for this reason
Date Owner.
WORKERS' COMPENSATION DECLARATION
I hereby affirm under 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
;� of the work for which this permit is issued.
1 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
MY rsce ensat[
on. Insurance carrier and pollu�r�ymber are:
Carrier _�rl-,C2 P 4-1AAJ �J Policy Number // B
_ I certify that, in the performance of the work for which this permit 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 I should became subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
�l forthwith comply with those provis ns. /ten;
Date •' V ApplicantL&ek-/�/
—ka
WARNING: FAILURE TO SECURE WORKERS' C010PENSATION 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I hereby'affirm under penalty of perjury that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Sea 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT 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 or pursuant to any permit
Issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta,-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 Issuedas a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancp1toon.
I certify that 1 have read this application and state that the above in mma 'on 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 ent upon above-mentioned for inspection purposes.
Data " Signature (Applicant or Agent):
Page . 2
Application Number . . . . .04-00003870
Date 5/20/04
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
8.25
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 ONLY. ALARMS
BARRIERS SHALL BE IN PLACE PRIOR
TO
.PREPLASTER INSPECTION.
Fee summary Charged
Paid Credited
Due
Permit Fee Total 291.00
.00 .00
291.00
Plan Check Total 148.35
.00 .00
148.35
Grand Total 439.35
.00 .00
439.35