04-6001 (RPL)N
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BUILDING & SAFETY EPAR' MEI`T
(760).777-7012
TAMPICo FAX (760) 777-7011
\LIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
I -- _ _,! BUILDING PERMIT.:' M.
CITY OF LA QUINTA
FINANCE DEP-:
Applicat-ion Number 7L_O4=-0.00-06.001 Date
Property_Address . . 81929 SUN CACTUS LN
APN: 764-270-999-17 -300231-
Application description . POOL -RESIDENTIAL
Property Zoninq . . . MEDIUM.HIGH DENSITY RES
,Application valuation 17000
Owner
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE AZ 85258
Contractor
-------------------
CALIFORNIA POOLS & SPAS'
P.O. BOX 1280
8/23/04
COACHELLA CA 92236
(760) 398-9222
Qty Unit Charge Per Extension
BASE FEE 15.-00
'WCC: STATE FUND
WC: 04'600061168
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
2,001-25,000 -.
135.00
Permit .
. . .
MECH POOL
Additional
desc
-..
Permit Fee
.
. . 24.00
Plan Check Fee
6.D0" --
.30+" -
Issue
Issue Date
Valuation
0
Qty
Unit
Charge Per
Extension
BASE
FEE
15.)0
1.00
9.0000 EA MECH
FURNACE <=100K
9..)0 "
Permit
. .
. . ELEC POOL PERMIT -RES a
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 • VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Ozi- 4pco/
Applicant:
Applicant's Mailing Address:
Date: 'g--CA-1_6q
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under p ions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
e s
.ode and my Lice i n II force and effect.
License Class Licens No. Y2J
Date 61�� Contractor
OjNNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from t C ractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city of 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 1, 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
WORKERS' COMPENSATION DECLARATION
I hereby affirm under 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, for the 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
is ueg,.My wo rs' compensation i rance came n olicy n mb r r :
Carrier r ' olicy Number
I certify that,�rm he performan a of the work for whic his peis issued, I shall no employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, i I should be me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those pr 'sions.
Date9z 06 Applicant
WARNING: FAILURE TO SECURE WOR ERS' COMPENSATIO COV RAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THO SAND DOLLARS ($1 IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S 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 (Sec. 3097, Civ. C.).
Lenders Name
Lenders 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 d all, defend, indemnity and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the work bei perf0 eshd under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if w )rk i not co enced 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 anon is correct I ag a to omply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county t nter upo the ab ve-m do ad property for inspection purposes.
ate lac�--Stgnature (Applicant or Agent):
Page 2
Application Number . . . . 04-00006001
Date 8/23/04
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, STUB FOR FUTURE APPROVED
APPLIANCE. 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.