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04-7499 (RPL)opo QgW� BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760)•777-70.12 OFTt 9 78-495 CALLS -TAMP.ICO FAX (760) 777=7011 LA QUINTA, CALIFORNIA.92253 INSPECTION REQUESTS (760) 777-7153 BUILDING: PERMIT Application Number 04-00007499 Date 11/30%0,4 Property .Address.-.. . . . . . . 81321 GOLDEN BARREL- WY ..APN: 764-270-999-88 ,,!300233-. Application description.:. POOL. RES IDENT IAL Property Zoning . . .... . MEDIUM HIGH DENSITY, RESP- Application valuation..; - 2.000 Owner. Contractor SHEA LA QUINTA CALIFORNIA POOLS & SPAS C/O 'JEFF MCQUEEN P.O. BOX .1280. .880O . -N GAINEY CENTER. 350COACHELLA CA .92236 SCOTTSDALE AZ 85258 .(760) 398-922.2... WCC:.'.STATE FUND.. WC 04600067168 0`1/01/05. CSLB_ 656128. 1.0/31/06 CCC: C8=C2`7-C29-053 Permit . . . MECH POOL Additional desc Permit.Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . Valuation 0.: Qty" UnitCharg BASE FEE e: .Per Extension • 15.00 1'.00 9.0000 EA MECH FURNACE <=100K 9.00 .Permit BLDG POOL PERMIT Additional desc Permit.Fee 45.00 Pian Check Fee°. 29.25 Issu.e.Date..Valuation 2000 Qty Unit Charge Per Extension BASE FEE 15:00 15.00. .2.0000 HND BLDG 501-2,000 30.00.' 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. 1.00 30.0000 EA ELEC PRIVATE' SWIMMING POOL 30.00 Permit PLUMBING Additional desc P.6. Box 1504• • al, 79-495 CALLS TAMPiCO I,A QUiNTA, CALIFORNIA 92253 Application Number. Applicant: :Applicants Malling Address,4- BUILDING & SAFETY DEPARTMENT VOICE (760) 7.77-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-17153- . Applica'rits 77-7153 Date: Architect or Engineer Architect or Enoi ydrdss: Uc. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby aff ni under penalty of perjury that f am rmcensed under pro�Asiorms of Ctmaptsr 9 (oommendng wftim Section 7000) of DFAdon 3 of the'Buskmess and Professionals License ClaCode. and ss �� $In 3 tome and effect• Licari, No. lD(o I2 S . Date Contractor OWNER -BUILDER DECLARATION 1 hereby afrirm'under penalty of perjury that I am exempt from the Contractors' State LIoense Law for Nie fogoMAnp mason (Sea 7031.5, Buskmess end Professions Code Any city or county that requires a permit to conatn4 alter, Improve, demolish, or repair any structure, prior to Its Issuance, also M*kas the sp*ant for the. permit to Sea signed statement that he or she Is licensed pursuant to the provisions of the C.ontraclore State License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Pm%sslons; Co4e) or VW 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 rive hundred dollars ($500).r () 1, as owner of the property, or my employees with wages as thele sole compensation, will do the work, anis to structure is not intended or offered for sale (Sec. 7044, . husinm and Pialml ms Code: The ContradW State L.loense Low does not apply b sn avmerct property who 11K" Of improves thereon, and who does the work himself or herself or ttuough his or her own employees. provided Chat the Improvemenla.are not intended or ofted for safe. If. however, the bullQiq or improvembnt (s " sold witttln one year of completion, the owner4x Aden wW have the burden of proving that hear she did not build orimprove tot the purpose of sale.). () I. as owner of the property. am emodasiyrely contracting with licensed contractors to construct the project (Sea 7044, Business and Professions Code: The Contractors' - State License law does not apply to an owner of property who builds or hp. thereon, and who contracts for the projects with a contractors) licensed pursuant to time contractors` State License Law.). (, I am exempt under Sea . BA PSC. for eds reason Date Owner. ':. WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following dedaratioas:, 1 have and.wIll maintain a certificate of consent to self insuni for workers" conpenudon, as provided for by Section 3700 of the Labor Code. for the performance, of the work for witch this permit is Issued.. I have and will maintain workers' compensation insurance, as required by -Section 3700 of the Labor Code: for the performance of the work for which this permit is MY Von. Insurance carrier and poii�ypynmbor aro: Cartier, <r- P •t�� Policy Number D S�(o/9M //% � I.oartify that In the performance of the work for which this permit is issued, l shall not employ any person in any manner. so as to become subject to the workers' compensation taws of CaGfof ,4 and agree that, it.l should become subject to the worIme eompanselon provisions of Section 3700 of the Labor Code, I shad for$ryNtlm comply with Ime provlogns. WARNING: FAILURE TO SECURE WORKERS' C014PENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (1100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 hereby affimmm under penalty of perjury that them Is a construction lending agency for the pedomnence of the work for which tide permit 1s Issued ($ea 3097, Civ. C.). Lenders Name. Lenders 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 appACatiori. 1. Each person upon whose behalf this sppAcation los made. each person at whose request and for whose Benefit worts Is performed under or pursuard to any permit issued as a result of this application, the owner, and the. applicant, each agrees to, and shall, defend, kdemnify and hold hamnless the City of L8 Omrinta. Its officers, agents and employees for any ad or omission related to the ` perfammed under or following Issuance of Itis pemdl 2 Any permit Issued as a resmAt of this application becomes null and wt not commenced wittdn 180 days from date of issuance of such pemdt, 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 gree to comply with art city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county tar boned property for inspection purposes. Date Signature (Applicant or Agent): c Page 2 Application Number . . . . . 04-00007499 Date 11/30/04 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 WATER FEATURE ONLY. Fee summary Charged --------------------------- Paid Credited Due Permit Fee Total 141.00 -------------------- .00 .00 ---------- 141.00 Plan Check Total 53.2.5 .00 .00 53.25 Grand Total 194.25 .00 .00 194.25 c