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05-0078 (RPL)T4hf 4 4 a" 504 _LE TAMPICO CALIFORNIA 92253 BUILDING PERMIT Property Address APN: Application description Property Zoning . . . . Application valuation BUILDING & SAFETY DEPARTMENT (760),777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 05-00000078—Date .1VF8-1',2;6'6�GOLDENf BARREL WY�� 764=2-70-999-100 -300233- POOL — RESIDENTIAL MEDIUM HIGH DENSITY RES 8000 1/12/05 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-C29-053 ---------------------------------------------------------------------------- I V• P.O. BOX 1504ICE 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: Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: LAL Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I h eby affirm under penalty of perjury that 1 am licensed u rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals „Bode, and my Licen s m II rce and effect. �^// (/ License Class I - �' cens No. tfO % G/i ate 6 "Contractor 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 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 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 d will maintain rkers'compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ii d.workers' mpensation insurance carrier a d Iic r nu�(nber ire Carrier c� Policy Number o� U i) (r� f lam' _ I certify that, in the performance of the work for is permit is issued, I shall not Mptoy any person in any manner so as to become subject to the workers' compensation laws of California, and agree at, if I hould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pro ons. "Date 2 6 A" pplicanI WARNING: FAILURE TO SECURE WORKERS' CO ATION 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 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, indemnity 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 issued as a result of this application becomes null and void if wo is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. 1 certify that I have read this application and state that the above information is e . agree to mply with all city and county ordinances and state laws relating to building co nstruction, grid hereby authorize representatives of this county to ter upon e o e -menti d property for inspection purposes. / 2 /Os Signature (Applicant or Agent): Y 7 � - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Application Number . . . . . 05-00000078 ---------------------------------------------------------------------------- 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 99.00 Plan Check Fee 64.35 Issue Date . . . . Valuation . . . . 7680 Qty Unit Charge Per Extension BASE FEE 45'.00 6.00 9.0000 THOU BLDG 2,001-25,000 54.00 ---------------------------------------------------------------------------- Permit . . . . . . Additional desc . . Permit Fee . . . . Issue Date . . . . ELEC POOL PERMIT -RES 45.00 Plan Check Fee 11.25 Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 EA ELEC ---------------------------------------------------------------------------- PRIVATE SWIMMING POOL 30.00 Permit . . . . . . PLUMBING Additional desc . Permit Fee . . . . 27.00 Plan Check Fee 6.75 Issue Date . . . . Valuation . . . . 0 Qty' Unit Charge Per Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 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 320 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments. SPA ONLY. 20 LF OF 4' BLOCKWALL PER CITY STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. Fee summary Charged Paid Credited Due ------------------------------------- Permit Fee Total 210.00 -------------------- .00 .00 210.00 Plan Check Total 88.35 .00 .00 88.35 ---------------------------------------------------------------------- - - - - - - Application Number . . . 05-00000078 Grand Total 298.35 .00 .00 298.35