The URL can be used to link to this page

RPL (04-5604)55255 Medallist Dr 04-5604 BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760),7.77-7012 OF9 78-495 CALLE TAMPICo FAX (760) 7.77-7011 LA Qu[NTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)777-7.153 BUILDING PERMIT Application Number, 04— _05-6-0 4 Date Property Address . . . . . 55255 MEDALLIST DR .7/22/04 APN: 767-510-002- - - Application description ;"POOL - RESIDENTIAL I1 Property Zoning . . . . . LOW,DENSITY RESIDEN'i L Application.valuation 17000 AUL 26 2004 Owner Contractor, CITY OFLAO UII T ------------------ - - - - -- --__ N-oF® NORMAN ESTATES I:I CALIFORNIA POOLS &`"SPAS C/O MEDALLIST GOLF DEVELOPMENT P.O. BOX 1280 501 NORTH AlA COACHELLA CA 92236 JUPITER FL 33477 A760) 398-9222 WCC. STATE 'FUND. WC: 04`6000611.68• 01/01/05 CSLB: 6'56128 10/31/04` CCC: 'C8 -C27 -C29-053 Permit . . . . . . BLDG POOL PERMIT f Additional desc Permit Fee . . . . 180.00 Plan Check.Fee v. 117.00 Issue Date . . . Valuation 17000 Qty Unit Charge Per Extension BASE FEE 45.00 15.00 9.0000 THOU' BLDG 2,001=.25,000 135.00 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 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 1504 • , VOICE (760) 777-7017 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: - 5(00q Date - Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: /A 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 (com eppcing with Section 7000) of Division 3 of the Business and Professionals C e, and Liceryse i jell force and effect. icense Class (` �j is se o. Uc b Date 6/evcontractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt fromcontractors' 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 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 orkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is / is d. worker ' compensation insyGance carrier andp9licxnumt�er�re: �rrier h acv Number _ O �/ L•� Cl%�U (o l % (p�( certify that, in the performance of the work for whichthi rmit 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 that, jf I oul become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. / I M WARNING: FAILURE TO SECURE WORKS - COMPENSAT�VERAGE 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 eing erfortned under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if ork ' not menced within 160 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to canceHation. I certify that I have read this application and state that the above information isme" e . agree t comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this count enter upon he o e -me ioned property for inspection purposes. ate .ala& /Le/ Signature (Applicant or Agent): Page 2 Application Number . . . . . 04-00005604 Date 7/22/04 Qty Unit Charge Per Extension 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 Permit . . . . . . PLUMBING . Additional desc 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 3.00.00 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 POOL/SPA. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee summary. Charged Paid Credited Due Permit Fee Total' 282.00 .00 .00 282.00 Plan Check Total 142.50 .00 .00 142.50 Grand Total 424.50 .00 .00 424.50 A 11 It j Tit ti R, MAN NO RLS PHONE LIDT SCALE JOB je 14 -ON U' T T ID N' S, TR T A 4 `-JOR I Z A---, 10 c U C I iv ic ` ot� Ile MMit A 11 It j Tit ti R, MAN NO RLS PHONE LIDT SCALE JOB je 14 -ON U' T T ID N' S, TR T A 4 `-JOR I Z A---, 10 c U C I iv ic `