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04-6412 (RPL)Tdf 4 TAMPICO :ALIFORNIA 92253 BUILDING PERMIT Application description . . Property Zoning . . . . . Application valuation . . . Owner SHEA LA QUINTA C/O JEFF MCQUEEN 8800 N GAINEY CENTER 350 SCOTTSDALE AZ 85258 BUILDING & SAFETY DEPARTMENT (760) .777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 04-00006412 Date 813 41 GOLDEN BARREL WY 764 -270 -999 -104 -300233 - POOL - RESIDENTIAL MEDIUM HIGH DENSITY RES 12000 Contractor 9/23/04 SHEA HOMES, INC. 81260 AVENUE 62 LA QUINTA CA 92253 (760) 777-6005 Qty Unit Charge Per Extension BASE FEE 15.00 WCC: NTL UNION INS WC: 6436568 08/01/05 CSLB: 672285 06/3.0/05 CCC: B. ---------------------------------------------------------------------------- Permit . . . . . . BLDG POOL PERMIT Additional desc Permit Fee 135.00 Plan Check Fee 87.75 Issue Date Valuation . . . . 11936 Qty Unit Charge Per Extension BASE FEE 45.00 10.00 9.0000 THOU BLDG 2,001-25,000 90.00 ---------------------------------------------------------------------------- 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 9.00 ----------------------------------------------------------7----------------- Permit ELEC POOL PERMIT -RES 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 1504VOICE (760) 777-701' TVf 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING S SAFETY DEPARTMENT Application Number: 0 41Date: q a2 ?•aY Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS neN ED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed andons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals gode and my Ll c a is force and effect. ,,--'License Class L' V lFJ p —OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that f 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 o1 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: _ 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. have and will maintai orkers' compensaf -insurance. as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is is rkly worke rcompensatio ca urance 'er a cy ofcxnymger r arrier Y -C( l�( Policy Num r _ I certify that, in the performance of the work for Jyhich thi 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, if Is ould become subject to the workers' compensation provisions of Section 3700 of the labor Code, I shall forthwith comply with those pAvisions. , G! WARNING: FAILURE TO SECURE WORKERS' COMP AT N 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 14 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 perfortned under or pursuant to any permit issued as a result of this application, the owner, and the applicant, ea to, and shall, defend, indemnity and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission related to ork halo erfortned under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and o' if work is 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 rect. I ato comply with all city and county ordinances and state laws relating to building construction, and herby authorize representatives of this county enter upo ve�nlfioned property for inspection purposes. /Date a �(/®YSignature (Applicant or Agent): i 3 Page 2 Application Number . . . . .. 04-00006412 Date 9/23/04 Qty Unit Charge Per Extension 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 ---------------------------------------------------------------------------- Special Notes and Comments SPA, 4 L.F. 4' BLOCK WALL, CITY STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. Fee summary Charged ---------'-------- Paid Credited Due ---------- Permit Fee Total ---------- 231.00 ---------- .00 .00 ---------- 231.00 Plan Check Total 111.75 .00 .00 111.75 Grand Total 342.75 .00 .00 342.75