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04-4560 (RPL)BUILDING.& SAFETY DEPARTMENT P.O. BOX 1504 (760).777-7012 OF78-495 CALLE TAMPICO FAX (760) 77.7-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-,7153. BUILDING PERMIT Application Number 04--0-0-004-5.6.0 Date 5/25/04 Property Address . . 60694 WHITE SAGE DR APN: 764-270-999-104 -300231- Application description . . . POOL - RESIDENTIAL Property Zoning .... . . MEDIUM HIGH DENSITY RES Application valuation . . . . 17000 Owner Contractor ---------------- ------ SHEA LA QUINTA. --- ---- -- CALIFORNIA POOLS ----- & SPAS C/O,JEFF.MCQUEEN P.O. BOX 1280 8'800 N GAINEY CENTER 350 COACHELLA CA 92236 SCOTTSDALE 'AZ 85258 (760) 398-9222 WCC: STATE FUND WC: 046.00061168 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. 6.00 Issue Date Valuation 0 Qty Unit Charge Per Extension - BASE FEE 15:00 1.00 9.0000 EA MECH FURNACE <=100K I 9.00 -------------------------------- Permit . ... . . . ELEC POOL PERMIT ----------- .---------------------- -RES. Additional desc Permit Fee' 45.00 Plan Check Feel,.., 11.25 Issue Date Valuation 0" Qty, Unit Charge Per ,Extension - BASE FEE . .1-5.00 1 P.O. BOX 15044 /�� 78-495 CALLS TAMPICO N VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-701 1 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 Application Number: 044- 415(90—Date: Applicant: I Architect or Engineer: Hppiicanrs Malting Address: rvcrntect or tngjneer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter g�commen g with Section 7000) of Division 3 of the Business and Professionals Code, and my License i in Ifo a and effect.i^ Z /License Class ,cense No._ Date �ontraaor I herebyaffirm under OWNER -BUILDER DECLARATION 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 1, 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 orimproves 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 1 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 �wrkers'compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is 45)ise . My n in cce carrier and policy numb�D Cartier oliP' cy Number v �� _ty that, in the Pertormance of the work for which this permit ,s issued, I shall not employ any person in any manner so as to become subject to the workers' 69 compensation laws of California, gree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pro sion . 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. 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 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 pursue 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 Le Ouinta, its nt to any permit 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 dayml 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 applicaliori and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of t is county to enter u above�rmentioned property for inspection purposes. Date !� Signature (Appli . r��Q t.•�:r.�.wyl 6'1 .u'riv v^QT,�;P, - .i T ` Page. 2 ".Application Number . . . . . 04-00004560 Date 5/25/04 Qty Unit Charge Per Extension 1.00. 30.0000.EA ELEC PRIVATE SWIMMING POOL 1 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 kh 1.00 3.0000.EA PLB WATER INST/ALT/REP .3.00 1.00 31.0000'EA PLB GAS PIPE 1-4 OUTLETS 3.00 --------------------------------------------------- special Notes Notes and Comments POOL, SPA, BBQ (ANSI Z21.58-1995). 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