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RPL (05-0299)55580 Medallist Dr 05-0299 0 u crcv BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760).777-7012 OF1 7N_7_9';_4_9_5_C_A:'r_7LE TAMPICO FAX (760) 777-7011 -A-%UINTjA11 CALIFORNIA 92253, INSPECTION REQUESTS (760) 777-7153 JAN 31 2`11 BUILDING PERMIT CITY OF LA QUINTA r App -14 -ea Mi'l- Ve n! TmflNumber . . . . . . _05=000002.99_ Date 1/28/05 Property Address . . . ... .. 5-5580 MEDALLIST DR APN: 767 -510 -016 - Application description POOL -*RESIDENTIAL Property Zoning . . . .. . . . LOW DENSTTY RESIDENTIAL Application valuation 28000 Owner Contractor ------------------------ ------------------------- NORMAN ESTATES II VICTORIA LANDSCAPES/WATERFALL C/O MEDALLIST GOLF DEVELOPMENT 82365 HIGHWAY 111, SUITE 41-04 501 NORTH AlA INDIO CA 92201 JUPITER FIT, 33477 (760) 863-3808 WCC: EVEREST NTNL WIC: 3800002849041 08/26/05 CSLB: 801813 12/31/05 CCC: C27-053 -------------------- --------- ------ ---------------------------------------- Permit MECH POOL Additional desc Permit Fee 26.00 Plan Check Fee 6.50 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 11.0000 EA 'FURNACE' '>100K 11.00 ----------------------- --------- 7 ------------------------------------------- Permit . . . . . . .BLDG POOL PERMIT INV FEE Additional desc Permit Fee . . . . 543.00 Plan Check Fee 176.48 Issue Date Valuation -280.00 Qty Unit Charge Per Extension i BASE FEE 504.00 3.00 13.0000 THOU BLDG 25,001-50,000 39.00 ----------------------------------------------------------------------- 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 ----- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - -- - - 5-------------.------- - ----- - ---------- Permit -------Permit PLUMB Additional desc s' P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: D. 7 Date: / -.2$ .0 Applicant: I Architect or Engineer: Applicant's Mailing Addre s: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirmunder nalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Li a is' rce License Class License No. Date- 05 Contractor OWNER48UILDER DECLARATION I hereby affirm under penalty of perjury that 1 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 _ ue rke s o q sation insurance r y rQ9Y,l !/ Carrier I /! / // Policy Number 2i UVV e;4.9 7 7 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 Califom' and agree that, if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pr Bions. .1 rl . Date Applicant WARNIG: F ILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL F ES 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 1 have read this application and state that the above info anon is cored. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to a er upon the above r tenGon roperty for inspec ion purposes. Date Signature (Applicant or Agent): Page 2 Application Number . . . . 05-00000299 Date 1/28/05 Permit Fee. 30.00 Plan Check Fee 7.50 Issue Date . Valuation . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 2.00 3.0000 EA PLB WATER INST/ALT/REP 6.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS- 3.00 --------------------------------------------------------------------------=- Special Notes and Comments POOL & SPA. PERMIT DOES NOT INCLUDE EQUIPMENT ENCLOSURES. ALARMS & BARRIERS MUST BE IN PLACE PRIOR TO PREPLASTER INSPECTION.INVESTIGATION FEE ASSESSED FOR WORK BEGUN WITHOUT PERMIT. Fee summary Charged Paid Credited Due Permit Fee Total 644.00 .00 .00 644.00 .Plan Check Total 201.73 .00 .00 201.73 Grand Total 845.73 .00 .00 845.73 ' 1 FROM FAX N0. Apr. 07 2004.01:42PM P2 CITY OF FOR OVE c aDr k , .. CONSTRUCTION D : aZi A ' - fn *DA, LU 6ATA STD ,Tl MAS u SUITE iI I6' X 210 k ? t xoaK -- BAx , Fi) i r `t