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RPL (05-0203)55775 Medallist Dr 05-0203 BUILDING & SAFETY DEPARTMENT 504 (760).777-7012 _LE TAMPICO FAX (760) 777-701.1 CALIFORNIA 92253 INSPECTION REQUESTS (760) 777=7153 BUILDING PERMIT A`R ` PAmi eat '-.— " pp.rC^Q ,on Number ----__ 05 000.0.0.203 Date 1/31/05 PropertyPAddress . . . ,55775 MEDALLIST DR APN: - 767-500-001- - - Application description . POOL'- RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 28000' Owner Contractor EHLINE CO. VICTORIA LANDSCAPES/WATERFALL 55-775 MEDALLIST.DR. .82365 HIGHWAY 111, SUITE #104 LA QUINTA CA 92253 INDIO CA 92201 (76.0) 863-3808 WCC': EVEREST NTNL WC: 3800002849041 08/26/05 CSLB: 801813 12/31/05 ----------------------------------------------------------------------------- CCC: C27-053 .Permit BLDG POOL PERMIT Additional desc Permit Fee°. 271.50 Plan Check Fee 176.48 Issue Date Valuation, 28000 Expiration Date 7/28/05 Qty Unit Charge Per Extension BASE FEE 252.00 3.00 6.50.00 ------------------------------------------------------------------------------- THOU BLDG 25,001-50,000 19.50 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 3'0.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 Permit . . . . . . 'PLUMBING Additional desc Permit Fee 33.00 Plan Check Fee 8.25 Issue Date Valuation . . . . 0 Expiration Date . 7/28/05 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 P.O. Box 1504 78-495 CALLE TAMPICO qY VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: G -- a0 3 a -CJ'• OS Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No., BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm ugAer penalty of perjury that I am licensed under provisions o Chapter 9 mmencing with Section 7000) of Division 3 of the Business and Professionals C e, and my jetcAns�9in r d effect �(/ 2 . icense Class (/,+ i ��nse No. �A®1 U6_ J air to Contracto OWNER -BUILDER DECLARATION 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 sate (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 1 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. 1 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 Califomia, nd 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 pr i ons. "Date 6? J Applicant WARNING: AILURE TO SECURE WORK S' COMPENSATION COVERAGE IS UNLAWFUL, D 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 1 hereby affirm under penalty of perjury that t/lere 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, indemnity and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission related to the work being perforned 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 �o ation is correct. I a to com ly 'th all city and county ordinances and state laws relating to building truction, and hereby authorize representatives of this coun to nter upon abov n on p rty for inspection purposes. Dat b�Signature (Applicant or Agent). 11p Page 2 Application Number . . . . . 05-00000203 Date 1/31/05 Page 2 Application Number . . . . . 05-00000203 Date 1/31/05 Qty Unit Charge Per Extension 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- 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 -------------------------------------------------------------------------- Special Notes and Comments POOL .& SPA ONLY. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION.EQUIPMENT ENCLOSURE NOT- OT_INCLUDED INCLUDEDIN PERMIT. Fee summary Charged Paid Credited Due Permit Fee Total 373.50 .00 .00 -373.50 Plan Check Total 201.98 .00 .00 20.1.98 Grand Total 575.48 .00 .00 575.48 ja GY . > r D fp . .. .4 fa G ^- i _ i{ kA . ro CITY' OF LA CSU NTA r, o ( BUILDING & SAFETY DEPT. APPROVE FOR CONSTRUCTI DATE 5 O S BY N n n r '