RPL (07-2292)57131 Medinah
07-2292
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760)777-7153
BUILDING PERMIT
Date: 8/13/07
Application'Number: 07_--0 0-00 2 2 9 2---f Owner:
Property Address: 57131 MEDINAH , DOTTO ROY D
APN: - 762-110=034- - — 57131 MEDINAH
Application description: POOL - RESIDENTIAL LA. QUINTA, CA 92253
Property Zoning: LOW" DENSITY RESIDENTIAL
Application valuation: 32500 D
d
Contractor:
Applicant: Architect or*Engineer: PLATINUM POOLS & SP
77564 COUNTRY CLUB RI E Ap 04 2007
PALM DESERT, CA 92'2 1
(760) 772 4274; C1 OP
Lic. No.:' 890670 F NAN F UI )v
r
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that am licen d under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury'one of the following declarations: -
Section 7000) of Division 3 of the Business d Pro ss nals Code, and my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided -
License Class: C53 - Li nsa No.: 890670 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is—
`p . issued.
Co actor: ,. Yl 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are: .
I hereby affirm under penalt f perjury tha 1 am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 1863573-2007
following reason (Sec. 7031 .5, ess d Professions Code: Any city or county that requires a permit to _ I certify thdRCODE
performance he work for which this permit is issued, -I shall not employ any
construct, alter,. improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the personanner o s t be ome subje o the workers' compensation laws of California,
permit to file asigned statement that he or she is licensed pursuant to the provisions of the Contractor's State - and agif I sh Id b om subject th workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 oor Cod , I s all f rt
co ly with"those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by Q '21r -•1"
any applicant for a permit subjects the applicant to a he
penalty of not more than five hundred dollars (55001.: ate: J : -
(_ ) 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 WARNING: FAILURE RE WOR RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYRIMINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the 'DOLLARS ($100,000).ITION T THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however; the building.or improvement is sold within SECTION 3706 OF THCODE NTEREST, AND ATTORNEY'S FEES.
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.). - APPLICANT ACKNOWLEDGEMENT
( 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. ; IMPORTANT Application is hereby made to the Director of Building and. Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of . conditions and restrictions set forth on this application. -
property who builds or improves thereon, and who,contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit -issued as a result of this application, -
.( ) I am exempt under Sec. , B.&P.C. for, this reason - . the.owner, and the applicarit, 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..
Date: Owner. "' 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
CONSTRUCTION LENDING AGENCY permit to cancellation. "
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the _ . I certify that I.have read this application and state that the abo a nfo ma on is rrect. I agree to comply with all
-work for which this permit is issued (Sec. 3097, Civ. C.). - - city and co ty ordinances and state laws relating to building str ma
n, an ereby authorize representatives
of t, unty to enter upon the above-mentioned property fo nsp ti pur ses.
Lender's Name: - -
ate: ' Signa a (Applicant or Agent):
Lender's Address:
LQPERMIT -
Application Number 07-000022921
Permit . . . BLDG POOL PERMIT
Additional desc .
Permit Fee'. 304.00 Plan Check Fee
197.60
Issue Date Valuation . . ..
.32500
Expiration,Date 2/09/08
Qty Unit Charge Per
Extension
BASE FEE
252.00
8.00 6.5000 THOU BLDG 25,001-50,000
52.00
- Permit ELEC POOL PERMIT -RES.
Additional desc .
Permit Fee 45.00 Plan Check Fee ..
11.25
Issue Date . . Valuation . . .
. 0
Expiration Date 2/09/08:
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 . . . . 27.00 Plan Check Fee
6.75
Issue Date . . . ". Valuation
0.
Expiration Date.2/09/08'
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 .6.0000 EA. PLB FIXTURE.
6.00
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
ADD POOL & WATERFALL TO EXISTING SPA.
EQUIPMENT ALREADY EXISTING.
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. FIREPIT BY.
SEPARATE PERMIT
Fee summary Charged Paid Credited
Due
Permit Fee Total 376.00 .00 .00
376.00
Plan Check Total 215.60 .00 .00
'215.60
Grand Total 591.60 .00 .00
591.60
•
LQPERMIT
Aug 09 07 08:09p 1
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. City of La Quints .
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P.Q Box 1504, 78.495 Calle Tanipfao
- !A'QuLttk'CA 92253 - (760777-7012
Building Permit Appfication and Tracking Sheet
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Legal Description:
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City, ST, Tap: Ulf t] l ► lk C .
Telephone 7t CO 7*2 9M
Pj.0Desawon:
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City, Sr, Zip_ A t,/N `/
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State ldc. erg
City Lu. d:
Asch, EM, Designer
Address:
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City, ST, Zip: -
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State Lia. #:
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CompactionY`ypc Occupazicir
Project type (circle me): New Add'a Alfa Repair Demo
Name of Contact Person: J n
S4 FL:
# Staries:
d Units
Telephone Y of Contact Person:
Estimated Valu of Project: a'M
APPLICANT: DO NOT WFtlTE BELOW THIS LINE
N > Submittal Raga Recd I TIMCMG PI tM1TFBffi
PhnSw
Pine Check submitted Item Anummt'
smMo ral Calm.
ljtev .ad, nadir for carteet ,u Plan Check Dcpmtt
bra•
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Called Contact Person Pian Check Bslauce
Title u Calm.
Flood Flab plan
?tens pieked up Constraeuan
lung resubmitted mechanical
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Grading pian
2"! Review, rndy far eormetiowmae Slecbiesi7.
Saboontaetor Iisr
;Wed Cootael Person Plumbing
_ Grant Deed
H.O.A. Approval
FlIaRspidadep
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Developer Impact Fcc
plan BAPprovalason
AJ.P.P.
Pub. Wks. APpr
Date of persnlf ieoc. -
Sehow Fees
Total Permit Fes
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED,
FOR CONSTRUCTION
DATED—Al 0? BYE
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