RPL (05-0535)BUILDING & SAFETY DEPARTMENT
x 1504 (760)'.77777012
�ALLE TAMPICO FAX (760) 777-7011
ITA, CALIFORNIA 92253 INSPECTION REQUESTS (7.60) 777-7153
BUILDING PERMIT
r '_05-00000535 Date
Property Address . . . . . . 81160 NATIONAL DR
APN: 767 -500 -02.4 -
Application description POOL- RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation 25000
2/10/05
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 .33477
(760) 863-3808
WCC: EVEREST-NTNL
WC: 3.8000-02849041
08/26/05
CSLB: .801813
12/31/05
CCC:. C'27-053-
7 ------------------------------------------------------------------
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
7 ---------------
------
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..
3.75
IssueDate . .
. .
valuation . . . .
0
Qty Unit.
Charge Per
Extension
BASE
FEE
15.00
1.00 30.0000
EA ELEC
PRIVATE SWIMMING POOL
30.00
---------------------------------------
Permit . . . .
. .. PLUMBING
7 --------------------- --------------
Additional desc
W
ciiFP.O. BOC 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: 65- X35
Applicant:
Applicant's Mailing Address:
Date:
Architect or Engineer:
Architect or Engineer's Address:
/) 1A
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm ugAer penalty ofperjury that 1 am licensed under provisions o h ter 9 mmencing with Section 7000) of Division 3 of the Business and Professionals
erode, and my buns it� I tri a d eff J j!
11 i
j License Class ' , - cense ( Y /
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 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
Dat@ t1 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.
have and will ma)ntain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
uo w 1Ecers' compensation ipwance cam �d3p icogpe. re:
rrier V policy Number. (/V �Q��/
I certify that in the performance of the work for which this permit is issued, I shall not employ any pers�6n in any manner so as to become subject to the workers'
compensationlaws of Califon , and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwittr comply with thos ro isions. 1___) _ e-)
WARNING: FAILURE TO SECURE WOR S' COMPENSATION COVERAGE IS UNLAWFUL, ANUHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THCXSAND 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
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 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 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 abov formation is correct. I agree to coml3ly with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this cc ty o enter upo the above- ntioned ftrty for inspection purposes.
Date Signature (A t :
(Applicant or Age 9 )
Page 2
Application Number . . . 05-00000535
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
1 ` 4�
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