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04-4563 (RPL)�F.fwa�rw BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLS TAMPICO FAX.(760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)'7'77-7153 Qty Unit Charge Per BASE FEE Extension • 15.00 BUILDING PERMIT Application Number 04-00004563 -.Date 5/25/04 Property Address. . . . . . . 60562 WHITE SAGE DR APN: 764 -270 -999 -109 -300231 - 'Application description POOL - RESIDENTIAL Property Zoning ... . . . . . MEDIUM HIGH DENSITY RES Application valuation 16000 Owner Contractor 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 •060) 398-922.2 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 171.00 Plan Check'Fee ..111..15 Issue Date Valuation 15675 Qty. Unit Charge .Per Extension BASE FEE 45.00. 14.00 9.00.00 THOU. BLDG 2,001-25.,000 126.00 Permit MECH POOL Additional. desc Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation .. 0 Qty t.,Unit Charge Per Extension BASE FEE 15..00 1.00 9..0000 ------------------------------------------------------------=--------------- EA MECH FURNACE r=100K 9.00 Permit . . . . . ELEC POOL PERMIT -RES. Additional desc . . Permit Fee . . . . 15.00 Plan Check Fee .. 3.75 Issue Date Valuation. 0 Qty Unit Charge Per BASE FEE Extension • 15.00 P.O. BOX 1504 78-495 CALLE TAMPICO ' LA QUINTA, CALIFORNIA 92253 Application NUfllber: _(2.q — q J (p Applicant: Applicant's Mailing Address: ------------- BUILDING & SAFETY DEPARTMENT Architect or Engineer: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer's Address: Lic. No. BUILDING PERMIT DECLARATIONS \ LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penal of perjury that I am licensed under provisions of Cl ppter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals c rinse Class e. and License i and effect. /�o Lice IA- OWNER-BUILDER DECLARATION I hereby affirm under penalty of 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 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 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 self4nsure 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 an will maintain w rkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is _ ' e w , ers' c mpensation insuWce carrier and policy nu /6artierq Number � ��y _ I ce ify Ihat, i the performance of the work for which this permit ms ms— sued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califortmjrftand agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Zi ions. If WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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. 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.). 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 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 Ouinta, 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 issued as a result of this application becomes null and void if work is not commenced within 180 dayi 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 i ration is correct. I agree to comply with oll.city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this ctrhbo nti for inspection purposes: nature Applicant or Agent e i ' Page 2 Application Number .... .04-00.004563' ---------------------------------------------------------------------------- Date 5/25/04 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 ---------------------------------=--------------------- Permit WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . Valuation 325 Qty Unit Charge Per Extension BASE FEE ---------------------------------------------------------------------------- 15.00 Special Notes -and -Comments POOL, SPA, 15 L.F. 5 - BLOCK WALL, CITY STANDARD ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. Fee summary Charged Paid Credited ----------------- Due ------------------------------ Permit Fee Total 258.00 .00 .00 ---------- 258.00 Plan Check Total 129.15 .00' .00 129.15 Grand Total 387.15 .00 .00 387.15