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05-1365 (RPL)55825 Medallist Dr 05-1365 P.O. BOX 1504 BUILDING & SAFETY DEPARTMENT CFM 78- CALLE TAMPICO (760).777-7012 FAX (760) 777-7011 D NTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 pPR 1 3 2005 BUILDING PERMIT CITY OF I p pI11NTA A CEDEPT.umber C_05_i00QQ1-36.5-•, Date 4/12/05 , Property Address . . . . . 55825 MEDALLIST DR APN: 767-500-002- - - Application description POOL - RESIDENTIAL Property Zoning . . . LOW DENSITY RESIDENTIAL Application valuation-. 65000 Owner Contractor SNEIDER VICTORIA LANDSCAPES/WATERFALL 557825 MEDALLIST DRIVE 82365 HIGHWAY 111, SUITE #104 LA QUINTA CA 92253 INDIO CA 92201 (760) 775-0449 WCC: EVEREST NTNL WC: 3800002849041 08/26/05 CSLB: 801813 12/31/05 CCC: C27-053 ----------------------------------------7-------------=--------------------- Permit . . . . . PLUMBING POOL INV FEE Additional desc Permit Fee . . . 66.00 Plan Check Fee 8.25 Issue Date _ Valuation 0 Qty Unit Charge Per Extension BASE FEE. 30.00 2.00 12.0000 EA PLB FIXTURE 24.00 1.00 6.0000 EA PLB WATER INST/ALT/REP 6.00 1.00 - 6.0000 EA PLB GAS PIPE 1-4 OUTLETS 6.00 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 . . . BLDG POOL PERMIT.INV FEE Additional desc Permit Fee 964.00 Plan Check Fee 313.30 Issue Date. . . . Valuation 65000 Qty Unit -Charge Per Extension BASE FEE 829.00 15.00 9.0000 THOU BLDG 50,0.01-100,000 .'135.00 Permit .. . . . ELEC POOL PERMIT -RES P.O.1504 78-4955 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: US/3(-S" Applicant: Applicant's Mailing Address: 0N77e 1 Cl rO iC Architect or Engineer: d�. VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer's Address: IVA Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and.Professionals 96deicen and ss Licegse,i@ ir1lyll forgeapd act. / , i W 13 /L�ice�ns'e)Class (' � ( V,� License No/ Contractor i✓ d 7 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 fora 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 , /9yed. w rkers' en at insurance carneyp0licn tuber [ arrier {' V C.11 %1 _Policy Number!/ 'S�((J n p� �� T / I certify that, in the performance of the work for which this pe it is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, nd agree that, if I should become object to the wi rkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisns. Dj Applicant WARNI G: FAILURE TO SECURE WORKERS' COMPENSATION 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.). Lender's Name 11 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 18V 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 info anon is correct. I agree to comply with all city and couhty ordinances and state laws relating to building construction, and hereby authorize representatives of this county t anter upon the above-mentioned pr spy for inspection purposes. av ler �% Signature (Applicant or Agent): G S' r 3. Page 2 Application Number . . . . 05-00001365 Date 4/12/05 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 Special Notes and Comments POOL & SPA. ALARMS/BARRIERS SHALL BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN PERMIT. INVESTIGATION FEE ASSESSED PER 1997 UNIFORM ADMINISTRATIVE CODE $304.5 FOR WORK BEGUN WITHOUT BUILDING PERMIT..' Fee summary Charged Paid Credited Due Permit Fee Total 1099.00 .00 .00 1099.00 Plan Check Total 338.80 .00 .00 338.80 Grand Total 1437.80 .00 .00 1437.80 r CITY OF LA QUINT.;' r' • BUILDING & SAFETY DEP. . APPROVED. ; . = FOR CONSTRUCTION 0 3'TV - yTSO SHQCES E� �2 C-YCi iLa.-CEo E vim _ NEA, 1.7 \t4 k�s,� y� -- t'cs3a�- -AT , NSE r:�::c ' ' e ♦ . ilt- . f 11.E vE r1EFg 3LS S� ,w•D, ��; - E,sE� ry Q�l COAT .6 Nysu r i 4 y y � 5�` 2 J`� -In ED At.iS' . b Z OL J 1 NT ,4 : CAq +zZ S %W rn-1 E F, ,ALxS* M . j�G A�.N c R_ r A' '�'• F+ins ���` � 7 st-CC�fE :1 .A c r _ LL © 1 ..# � �J p CA Iq Victoria Landscapes &Waterfalls ®• �, ° 'r '" 96�� L' 82-365 Hwy. 111, Suite 104 • , • r4 _ r Indio, Ca 92201 - a 'M A!Contractors Lic #801813 - J^