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05-1044 (RER)Ti4f 4 4 Q" BUILDING & SAFETY DEPARTMENT 3. Box 1504 %(760).777-7012 -495 CALLE TAMPICO FAX (760) 777-7011 QUINTA, CALIFORNIA 92253 INSPECTION .REQUESTS (760) 777-7153 °� ��eNo►a�` BUILDING PERMIT Application Number . . . . . 05=_00.0-01044 Date 3/24/05 Property Address . . . . . . 81242 GOLDEN BARREL WY APN: 764-270-999-98 -300233- Application description REMODEL - RESIDENTIAL Property Zoning . . . . . . . MEDIUM HIGH DENSITY RES Application valuation 500 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 (760) 398-9222 WCC: SEABRIGHT INS WC: BB1050510 01/01/06 CSLB: 656128 10/31/06 CCC: C8 C27 C29 C53 Other struct info . . . . . CODE EDITION 2001 -----------------------------------------------------------------=---------- Permit . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 15.00 Plan Check Fee 9.75 Issue Date . . . . Valuation . . . . 500 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Permit . . . . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee . . . . 15.75 Plan Check Fee 3.94 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension . BASE FEE 15.00 1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 .75 ---------------------------------------------------------------------------- Permit PLUMBING Additional desc . . Permit Fee . . . . 18.00 Plan Check Fee 4.50 Issue Date . . . . ,{ Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------7------------------------------ Special Notes and Comments BBQ -ANSI Z21-58-1995 PLUS GFI OUTLET/GAS r•, &V 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: 0,7- Jo 41 Date:,-? Applicant: ��^✓i��—T � Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: nl I4= Lic. No.: 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 Lice9se is fug force and effect. License Class C �^7 I L e se No. 6 61 1 X Date 37/211/ ! QJ Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from a 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 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.). L) 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: 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 �.q�syy��d��. p9y wor rs' compensation insurance carrier arld polio&umY�ay�:G'� r' Carrier JFe 1 Policy Number _ I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree t ^at, ' I s uld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date �l � ` �5 F aplicant 1�2 7 WARNING: FAILURE TO SECURE WORKERS' COMP SATIOeCOVERAGE 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 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 w' being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void ork i t commenced 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 information is co ect. I agre to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this count�tter upon th abo e- ntioned property for inspection purposes. Date cJZG/-1_1si Signature (Applicant or Agent): Page 2 Application Number . . . . ..:05-00001044 Date 3/24/05 -------------------- ------------------------------------------------------- Special Notes and Comments LINE. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE .98 Fee summary Charged ---------- Paid Credited Due ----------------- Permit Fee Total 48.75 -------------------- .00 .00 ---------- 48.75 Plan Check Total 18.19 .00 .00 18.19 Other Fee Total .98 .00 .00 .98 Grand Total 67.92 .00 .00 67.92