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RPL (04-7933)55460 Medallist Dr 04-7933 BUILDING & SAFETY DEPARTMENT >`v P.O. Box 1504 c IpF (760).777-7012 ti94`? 78-495 CAL LE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 9225 O TION REQUESTS (760) 777-7153 D 6 D EROM%%% Application Number . ._9 Date 1/31/05 Property Address . . . . DALLIST DR APN: -5107019- Application description . . . POOL- RESIDENTIAL Property Zoning . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . 28000 Owner Contractor MAUREEN SANDERS MONTEO VICTORIA LANDSCAPES/WATERFALL 55460 MEDALLIST DRIVE 82365 HIGHWAY 111, SUITE -#104 LA QUINTA CA 92253 INDIO CA 92201 ('760) 863-3808 WCC:' EVEREST NTNL WC: 3.800002849041 08/26/05 CSLB: 801813 12/31/05 CCC: C27-053 Permit . . . . BLDG POOL PERMIT - ADA INV FEE Additional desc Permit Fee . . . . 543.00 Plan Check Fee 176.48 Issue Date Valuation . . . . 28000' Qty Unit Charge Per Extension BASE FEE 504.00 3:00 13.0000 THOU BLDG 25,001-50,000 39.00 Permit . . . . MECH POOL ----- Additional desc Permit Fee 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation 0 Expiration Date 7./28/05.: 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 Expiration Date 7/28/05 Qty, Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 Permit . . . . . PLUMBING P.O. BOX 1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Num Applicant: Applicant's Mailing Address: Architect or Engineer: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: / Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm and r penalty of perjury that I am licensed udder provision f Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals ode, and my Liar Se is i fuJl4 le cense Class v f License No Date Contractor OWNER -BUILDER DECLAVATION 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 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 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 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 issued. My workers' compensation insurance carrier and policy number are: Cartier Policy Number _ 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 Califomi , nd agree that, if I sh come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forth 'th comply with those . vis ons. Z.te Applicant WARNI G: FA LURE TO SECURE WORKE 'COMPENSATION COVERAGE IS UN'LAWF AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOU AND 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 1 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 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 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 i oration is correct I ag comp with all city and county ordinances and state laws relating to building co y authorize representatives of this coun to anter upo abov ntion rty for inspection purposes. Date ( �/ ` (� Signature (Applicant or Agent): 4 Page 2 Application Number, 04-00007933 Date 1/31/05 Additional desc .Permit Fee 33.00 Plan Check Fee 8.2.5 Issue Date . . . . Valuation 0 Expiration Date . 7/28/05 Qty Unit -Charge Per Extension BASE FEE 15.00 2.00 6.0000 EA -1- 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 Special Notes and Comments POOL/SPA. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT -INCLUDED.,' INVESTIGATION FEE ASSESSED PER UAC 304.5 FOR WORK BEGUN WITHOUT A PERMIT. Fee. summary Charged- Paid Credited Due Permit Fee Total 645.00 .00 .00 645.00 Plan Check Total 201.98 .00 .00 201.98 Grand. Total 846.98 .00 .00 846.98 FROM FAX NO. Apr. 07 2004 01:42PM P2 •. j Iry t HCl 11i` 1, J 1 (ill( A NCi{9-. Cf t' F i1FCti!FJ 1E `,itJI! I . • MM 7-4- 004 CITY OF LA QUINTA i BUILDING & SAFETY DEPT. APPROVE® . FOR CONSTRUCTION tl.,' DA Z 0 gY i r • s ` . MASTER VU+ir. + '. ' t 71 Noo BAR . STER k