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05-1191 (RPL)La BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 OFTt� 8-495 CALLE TAMPICO FAX (760) 777-7011 QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 6 BUILDING PERMIT A Number . . . . .�--105=`0-00.01'1`91'. Date 3/30/05 flex Address 81405 GOLF VIEW DR A 762-410-040- - - Application descripti.on.. POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation 19000 Owner Contractor ------------------------ ------------------------ SRHI CALIFORNIA POOLS & SPAS C/O RIELLY HOMES INC P.O. BOX 1280 3 CORPORATE PLAZA DR 210 COACHELLA CA 92236 NEWPORT BEACH CA 92660 (760) 398-9222 WCC: SEABRIGHT INS WC: BB1050510 01/01/06 CSLB: 656128 10/31/06 CCC: C8 C27 C29 C53 ---------------------------------------------------------------------------- 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 198.00 Plan Check Fee 128.70 Issue Date Valuation . . . 18892 Qty Unit Charge Per Extension BASE FEE 45.00 17.00 9.0000 THOU BLDG 2,001-25,000 153.00 ---------------------------------------------------------------------------- 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 'c P.O. Box 1504 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: �� r %� Date: 4''S' Applicant: Applicant's Mailing Address: 60/V7-/�A C7-0 K Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS A/,A LICENSED CONTRACTOR'S DECLARATION I. !hereby affirm under enalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals �c ode, and my Lice i rce and effect. V License Class ice se ate �1 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 t, 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 ave nd will mainta" workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is e' is d. work com ensation insurance carneyh I' ey�r / / crier 7� p Policy Number`�O[OyCJCJ (J ` (Vr (� _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall / rthwi comply with those provi ions. Data �D Applican WARNING: FAILURE TO SECURE WOR RS' COM NS 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 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 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 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 c ect. I gree to comply with all city and county ordinances and state laws relating to building construction, and 7reD.A authorize representatives of this county to ter upon t bov mentioned properly for inspection purposes. Date / Signature (Applicant or Agent): Page 2 Application Number . . . . . 05-00001191 Date 3/30/05 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 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 108 Qty Unit Charge Per Extension BASE FEE 15.00 ----------------------------------------------------------------------------- Y Special Notes and Comments POOL & SPA. BBQ ANSI Z21-58-1995. 5 L.F. 5' BLOCK WALL, CITY STANDARD. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PRE-PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. Fee summary Charged Paid Credited ----------------------------------------------- Due ---------- Permit Fee Total 315.00 .00 .00 315.00 Plan Check Total 154.20 .00 .00 154.20 Grand Total 469.20 .00 .00 469.20