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RPL (04-5929)55295 Medallist Dr 04-5929 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT , Y Application Number 4, 04-400005929 - Date _ 8/13/04 Property Address . . ?--5-529 MEDALLIST DR APN: 767-5.10-,003- - - Application description POOL -•RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL Application valuation 16000 Owner Contractor NORMAN ESTATES II „CALIFORNIA POOLS & SPAS C/O MEDALLIST GOLF DEVELOPMENT P.O. BOX 1280 501 NORTH AlA COACHELLA CA 92236 JUPITER .FL 33.477 (760) 398-9222 WCC: STATE FUND WC: 04600061168 01/01/05 CSLB: 656128 10/31/04 CCC: C8 -C27 -C29-053 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 . . 171.00 Plan Check Fee 111.15 Issue .Date` Valuation 16000 Qty Unit Charge Per Extension BASE FEE 45..00 14.00 9.0000'THOU BLDG 2,001-25,000 126.00 --------------------------'-------------------------------------------------- Permit . . . . ELEC POOL PERMIT -RES Additional desc Permit Fee . . 45.0.0, Plan Check Fee 11.25 ,Issue Date, Valuation .0 Qty Unit Charge. Per Extension BASE FEE 15.0.0 P.O. BOX 1504'�C�� • w VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 04(_ Applicant: I Applicant's Mailing Address: Date: Architect or Engineer: Architect or Engineer'sdr s: V/ Lic. No.: BUILDING PERMIT DECLARATIONS NSED CONTRACTOR'S DECLARATION i I hereby affirm under penalty of perjury that I am licensed nde pro., SED of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Licen�g isiR fulL�force and effect. �� 2-9 Date ClasssJ / Ae No. Date ` �4 Contractor / /I,/ J OWNER -BUILDER DECLARATION I hereby affirm under penalty of pedury that I am exem Nmf�p_Se�Ct ontractors' 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 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 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ 1 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 mainForke's' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is i ued. workmpensation insurance carrier ,,��// is y4g�er are/- Carrier� Policy Number N1b bll�j _ I certify that, in the performance of the work for which is 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, if should come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall zforthwith comply with those provisions. Date Applicant WARNING: FAILURE TO SECURE WOR RS' CO ENS N COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TH SAND DOL S ($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 affirmunder 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 wo?gf rformed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void fcommenced 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 i co eto comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives ofthis o my enter u nth aioned property for inspection purposes. v� DateWo Signature (Applica�A nt): i 1Y • Page 2 Application Number . . . . . 04-00005929 Date 8/13/04 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 3.0000 EA PLB-WATER INST/ALT/REP 3.00 1.00 3:0000 EA PLB GAS'PI-PE 1-4 OUTLETS 3.00 Special Notes and Comments POOL &'SPA ONLY. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREP LASTER INSPECTION. EQUIPMENT ENCLOSURE NOT .,INCLUDED IN PERMIT. Fee summary Charged Paid Credited Due Permit Fee Total 273.00 .00. 00 273.00 Plan Check Total 136.65 .00 .00 136.65 Grand Total 409.65 .00 .00 409.65