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RPL (05-0523)55615 Medallist Dr 05-0523 3 ^' t9UILUING &'bAFETY DEPARTMENT P:O. Box 1504 (760).777-7012 Ohl 9 78-495 CALLE TAMPICO OF FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number ' r 05-()0_0Q_0_5.'2,3______,' Zbate2/1Q/05- property Address . . . .' .1 - 55615 `MEDALLIST DR APN: 767-510-012- - - Application description POOL - RESIDENTIAL Property Zoning :..,. . : . LOW DENSITY RESIDENTIAL Application valuation'. 25000 Owner Contractor NORMAN ESTATES II VICTORIA -LANDSCAPES -/WATERFALL C/O MEDALLIST GOLF DEVELOPMENT,. 82365 HIGHWAY 111,- SUITE #104 501 NORTH AlA INDIO CA 92201 JUPITER FL 33,477 (760) 863-38'08 WCC: EVEREST NTNL WC: 38000028.49041 08/26/05 CSLB: 801813 12/31%05 CCC: C27-053 Permit . . . . . BLDG POOL -PERMIT ------------------ Additional desc . Permit Fee 252.00 Plan Check Fee 163.80 Issue Date Valuation 25000 Qty Unit Charge Per Extension BASE FEE -"45.00 23.00 -9.0000 THOU BLDG ------------'----------°--`---=-=------'----=----------------- 2,001-25,000 207.00 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 3.7.5 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 - r 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: Date: 3-14- CL5 Applicant: I' Architect or Engineer: Applicant's Mailing Address: 14 Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS 1 Ir'FNCCn rnNT0APTn0142 neP. .-- .lion 7000) of Division 3 of the Business and Professionals vrrwc�c-ourLUMM utI.LAKAIIUN 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 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 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 ,,/ c'ers' com ensation Jl(�. rance cam ��c be e: q � r _ea'-er �: j/ ��/� p policy Number �/ vi', _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any peYsofi in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pr998ions. CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES S PROVIDED FOR NES AND 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 Ouinta, its officers, agents and employeesfor 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 correct. I agree to comply with all city and county ordinances and state laws relating to building ;ate nstruction, and hereb` authorize representatives of this coun enter upon t6,above- Ttioned operty for inspection purposes. .� G V ign�S ature (Applicant or Agent : a� �� C I. Page 2 Application Number . . ... . 05-00000523 Date 2/10/05 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 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 354.00 00 .00 354.00 Plan Check Total 181.80 .00 .00 181.80 Grand Total 535.80 .00 .00 535.80