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04-4125 (RPL)• Ot 4 " BUILDING & SAFETY DEPARTMENT Box 1504 (760).777-7012 j-45 CALLE TAMPICO FAX (760) 777-7011 A Q INTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . 04-00004125 '.!Date 3/10/05 Property Address . . . . . . 56043 BALTUSROL APN: 775-360-010- - - Application description . . . POOL - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 30000 Owner Contractor ------------------------ .RON & VICTORIA GRAY ------------------------ VICTORIA LANDSCAPES/WATERFALL 80632.BELLRIVE 82365 HIGHWAY 111, SUITE #104 LA QUINTA CA 92253 INDIO CA 92201 (760) 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. 284.50 Plan Check Fee.. 184.93 Issue Date . . . . 5./14/.04 Valuation . . . . . 30000 Expiration Date . . 11/10/04 Qty Unit Charge Per Extension BASE FEE 252.00 5.00 6.5000 THOU BLDG 25,001-50,000 32.50 ---------------------------------------------------------------------=------- Permit . . . . . . MECH POOL Additional desc . . Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . 5/14/04 Valuation . . . . 0 Expiration Date 11/10/04 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 11.25 Issue Date . . . . 5/14/04 Valuation . . . . 0 Expiration Date 11/10/04 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 ---------------------------------------------------------------------------- EA ELEC PRIVATE'SWIMMING POOL 30.00 Tit�/ 4 P.O. Box 1504�� VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 41 14 Date: • /D • D� Applicant: 1 Architect or Engineer: Applicant's Mailing Address: 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 provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Co nd my License is in full force and effect. cense Class �✓= icense No. 00, ontractor / 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 1, 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 i 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.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' . A 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 �•:.e� f wnerA(�e WORKERS' COMPENSATION [DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ 1 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 issued. My workers' compensation insurance carrier and policy number are: +' "Carrier 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 California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. N/_- /o WARNING: 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.). Lenders Name Lenders 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 above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. �te @�4tignature (Applicant or Agent): Page 2 Application Number . . . . . 04-00004125 Date 3/10/05 Permit . . . . . . PLUMBING Additional desc . . Permit Fee .. . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . 5/14/04 Valuation . . . . 0 Expiration Date 11/10/04 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 ONLY. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. -------------------------------------7-------------------------------------- Other Fees . . . . . . . . . CHANGE OF CONTRACTOR 4.50 Fee summary Charged ----------------- Paid Credited Due ---------- Permit Fee Total 386.50 -------------------- 386.50 00 ---------- .00 Plan Check Total 210.43 210.43 .00 .00 Other Fee Total 4.50 .00 .00 4.50 Grand Total 601.43 596.93 .00 4.50 Mar 03 05 03:37p CTX -USER 772-5572 p.1 RON AND VICTORIA GRAY 80-632 BELLE:RIVE LA-QUINTA, CA. 92253 LA QUINTA BUILDING AND SAFETY ATTENTION: TO WHOM IT MAY CONCERN PLEASE ISSUE A NEW JOB CARD FOR THE COMPLETION OF OUR POOL CONSTRUCTION PROJECT AT 80-632 BELLERIVE. TO VICTORIA LANDSCAPES AND WATERFALLS. WE HAVE RETAINED THEM FOR THE PURPOSE OF FINISHING THE POOL AND SPA. THEY SHALL PROVIDE INSURANCE AND LICENSE CERTFICATES FOR THIS PURPOSE. %d % -! 2 -- 3"S 7z _ —Mar -0.3. 05._03; 37P. r ZJM-USER 77z-s5'�c RON AND VICTORIA GRAY 80-632 BELLE:RIVE LA QUINTA, CA. 92253 LA QUINTA BUILDING AND SAFETY ATTENTION: TO WHOM IT MAY CONCERN 1 - PLEASE ISSUE A NEW JOB CARD FOR THE COMPLETION OF OUR POOL CONSTRUCTION PROJECT AT 80-632 BELLERIVE. TO VICTORIA LANDSCAPES AND WATERFALLS, WE HAVE RETAINED THEM FOR THE PURPOSE OF FINISHING THE POOL AND SPA THEY SHALL PROVIDE INSURANCE ANIS LICENSE CERTFICATES FOR THIS PURPOSE. MAR 0 4 2005 -73 0 w. �S i48o �x%�.r� Fe Few oil 1 6ALT �S ,\/•Sed �} 15 � � PD �- (p May 18, 2004 Ms. Esther Sanchez Riverside County Assessor's Office 3255 E Tahquitz Canyon Way, Ste 114 Palm Springs, CA 92262-6962 Dear Ms. Sanchez, Please be advised of an address change for the following structure. The structure formerly addressed as 80-632 Bellerive, permit # 0306-238, APN: 775-360-010, Lot 20, Tract 28961, is now addressed as: 56-043 Baitusrol Please note this change and contact me*directiy at (760) 777-7084 if 1 may be of further assistance. Sincerely, Kay Hensel Office Assistant I r, F . P.O. BOX 1504 BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICO (760) 777-7012 F T19� LA QUINTA, CALIFORNIA 92253 FAX 760 777-7011 May 18, 2004 Ms. Esther Sanchez Riverside County Assessor's Office 3255 E Tahquitz Canyon Way, Ste 114 Palm Springs, CA 92262-6962 Dear Ms. Sanchez, Please be advised of an address change for the following structure. The structure formerly addressed as 80-632 Bellerive, permit # 0306-238, APN: 775-360-010, Lot 20, Tract 28961, is now addressed as: 56-043 Baitusrol Please note this change and contact me*directiy at (760) 777-7084 if 1 may be of further assistance. Sincerely, Kay Hensel Office Assistant I r,