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RPL (05-0390)55655 Medallist Dr 05-0390 BUILDING & SAFETY DEPARTMENT P--.O.-'Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 . U } A' QU-INTCALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 ' Z) ;-LA - BUILDING PERMIT Application Number . . . . Date 2/03/05 Property Address . . s5 -- APN: ,' 767-500-002- - Application description POOL - RES IAL Property Zoning . . . . . . TY RESIDENTIAL Application valuation 18000 Owner NORMAN ESTATES II C/O MEDALLIST GOLF DEVELOPMENT 501 NORTH AlA JUPITER FL 33477 Contractor CALIFORNIA POOLS & SPAS P.O. BOX 1280 COACHELLA CA 92236 (760) 398-9222 WCC: SEABRIGHT INS WC: BB1050510 01/01/06 CSLB: 656128 10/31/06 CCC: C8 -C27 -C29-053 ------------------------------------------------------------------------------ Permit . . . . . . BLDG POOL PERMIT Additional desc . . Permit Fee . . . . 189.00 Plan Check Fee 122.85 Issue Date . . . . Valuation . . . . 18000 Qty Unit Charge Per Extension BASE FEE 45.00 16.00 ---------------------------------------------------------------------------- 9.0000 THOU BLDG 2,001-25,000 144.00 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 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 PIPE 1-4 OUTLETS 3.00 P.O. BOX 1504" VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 Tw�t444INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: q D I Date: - Ff' 05— Applicant: S Applicant: Applicant's Mailing Address: L � c 0�f Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals /Code and my Li c nse lull force and effect. License Class can No. �SLyI '/Date z �75 ��S' Contractor' OWNER -BUILDER DECLARATION I hereby affirm under pane Ity 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 rte a signed statement that he or she is IIcensed 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 sha is exam pl the re From 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 penally of not more than five hundred dollars (5500).): U I, as owner of the property, c my employees with wages as their sofa cam pansation, will do the work, and the structure is not intended or offered for safe (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 ane year of completion, the owner -builder will stave 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 contractors] The pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason 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. F I have agd will maI ' workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is iss work compensation insuranrhicthis polis number are' L,/'Carrier c�7 4: i PoI4 Nu I certify that, in the performance of the work foarmi is issued, I shall note ploy any person in any manner so as to become subject to the workers' compensation laws of California, and agreeld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions_ mate WARNING: FAILURE TO SECURE WORI(ERS' COMPENSATIOIV COVERAGE 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.). Lenders Name A I� Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application Is hereby made to the Director of Building and Safety for a permit subject to the condilion s and restrictions set forth on this application. 1. Each person upon whose behalf thls application is made, each person al 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 wol being performed under or following issuance of this permit. 2. Any permit issued as a result of this application hecames null and void if 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 cl. agr a to Comply with all city and county ordinances and state laws relating to buIIding construction, and hereby authorize representatives of Ihis counly to anter uporyh abov ntionad property for inspection purposes. Lhate �� Signature (Applicant or Agent): 14., Page 2 Application Number, 05-00000390 Date 2/03,/05 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 Special Notes.and Comments POOL & SPA. BBQ ANSI#Z21-58-1995. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION.. EQUIPMENT .<, ENCLOSURE NOT INCLUDED. Fee summary Charged Paid Credited Due Permit Fee Total 291.00 .00 .00 291.00 Plan Check Total 148.35 .00 .00 148.3.5 Grand Total :439.35 :00 .00, 439.35