04-5990 (RPL)ce
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BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 .(760).777-7012
OF=Tt9 78'4,951 CALLE TAMPICO FAX (760) 777-7011
LA=QIJI�NTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
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'. BUILDING PERMIT
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Apphi?catVN&&_Number 0_4_0.0:0.0:5-9=9-0_ Date 8/19/04
Property Address . . . . . . 80736 BELLERIVE
APN: 775-360-005- - -
Application description . . . POOL - RESIDENTIAL
Property Zoning . . . . . LOW'DENSITY RESIDENTIAL
Application valuation . . . . 35000
Owner Contractor
------------------------ ------------------------
KENNETH MEADOR OWNER
80736 BELLERIVE
LA QUINTA
CA 92253
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Permit . . . .
. .
BLDG POOL PERMIT
Additional desc
Permit Fee . .
. .
317.00
Plan Check
Fee
206.05
Issue Date
Valuation
. . .
. 341904
.Qty Unit
Charge.
Per
Extension
BASE
FEE
252.00
10.00
6.5000
THOU BLDG
25,001-50,000
65.00
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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
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Permit ..
ELEC POOL PERMIT -RES
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
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Permit . . .
. .
PLUMBING
Additional desc
Permit Fee . .
. .
33.00
Plan Check
Fee
.8.25
, y
P.O. Box 1504• �� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: O 207• 5 I qc) I 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 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
Code, and my License is in full force and effect.
License Class License No.
Date Contractor
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.).
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
I-Mte _ P ner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penally 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
issued. My workers' compensation insurance carrier and policy number are:
Cartier Policy Number
JS 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, I shall
forthwith comply with those provisions.
Date �� -t0 pplicant l�jG!�li��
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.).
Lender's Name
Lenders Address 0 A
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 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
I certify that 1 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.
ate a `2� % �gnature (Applicant or Agent):/C�l�G2
Application Number . . . .
Issue Date
Page 2
04-00005990 Date 8/19/04
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
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Permit .. . . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 15.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 96
Qty Unit Charge Per
Extension
BASE FEE
15.00
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Special Notes and Comments
POOL/SPA,.6 L.F. 4' EQUIPMENT ENCLOSURE,
CITY STANDARD. ALARMS/BARRIERS SHALL BE
IN PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT
Fee summary Charged Paid Credited
----------------- ---------- ---- - ----- ---------- ----------
Due
Permit Fee Total 434.00 .00 .00
434.00
Plan Check Total 231.55 .00 .00
231.55
Grand Total 665.55 .00 .00
665.55
OWNER / BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder'' you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law' to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
FAX 60) 777-701
OWNER'S SIGNATURE/DATE
PROPERTY ADDRESS
1)4- 5 !D
PERMIT NUMBER(s)
GOLF COURSE
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-
Y
ti lawn LOW 19' 1"AGE LIGHTS
sp
a yQ
( +18"
bench ;
+18"pool
�R
5 -'-� ' - -
30110 t 3� 19 2-
A s o `!^jar,
umbr Ila sleeve
decking
O LOW VOLTAGE LIGHTS decking
O mister system
............................ ..................
LOGGIA AREA
214'0 G/E
1 O DRAINS DOWN 5IDEYARD5 CORE DRILL AT CURB
ting wall H BENDER BOARD IS COMPOSITE BROWN
I SCREEN WALL TREES SHALL BE PLACED MIN. •5' FROM P/L
i P VINES SHALL BE ESPALIERED TO WALLS
FOR EQUIPMEN TREES AND TREE WELLS TO BE DEEP ROOT BUBBLERS
KENNETH AND ANNA MARIA MEADOR
(80=736 BELLERIVE -
EAGLE BEND HOMES
d•9 PGA WEST
T A !1T TT -XT?' A !'i A _
• • 1
P/L
O
O
F 14'0-
10'9-=-
wal I
bench
+18"
30'1
decking
LOW VOLTAGE LIGHTS
H
P
GOLF COURSE
lawn LOW \9'I AGE LIGHTS
`spa
+18"
9M
pool
5' 192\
�
A (o
5
sleeve
bbq
mister system decking
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.............
...................
...............................
LOGGIA AREA A RE -INSPECTION FEE 0 $30
WILL BE CHARGED IF THE APP OVED
D ARE 0
THE SIT,E, F A .SCHE ULE
DRAINS DOWN SIDEYARDS CORE DRIL4NkTP&ITKj px
BENDER BOARD IS COMP05ITE BROWN NO EX EP ONS!
SCREEN WALL TREES SHALL BE PLACED MIN. 5' FROM P/L
VINES SHALL BE ESPALIERED TO WALL5
FOR EQUIPMEN 7TREES AND TREE WELLS TO BE DEEP ROOT BUBBLi RS
KENNETH AND ANNA MARIA MEAD ITY OF LA QU 1 NI A .
80-736 BELLERIVE BUILDING & SAFETY DEFT. 9
EAGLE BEND HOMES APPROVED
PGA WEST FOR CONSTRUCTI N
T A 11T TTA T'T A !'1 A - DATE 04eo- BY
P/L
C43
,AI
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER OWNERS BUILDER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing, on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Fail a to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant.; "On File" is not an acceptable. response _.�
Trade / Classification
Contractor
State Contractor's License 7T
j`Workers Com ensation insurance ✓''�
City Business License
Company Name
Classification.
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTH ORK (C-12)
6�'21 51_-;5
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i r/✓%��((��%
�,
CONC 4ETE (C-8)
r
FRAMI G IC -5) '
STRU STEEL (C-51)
MAS NRY (C-29)
PLUM NG (C-36)
LATH PLASTER (C-35)
DRYW LL (C-9)
HVAC ( -20)
ELECT ICAL (C-10)
ROOFIN (C-39)
SHEET TETAL (C-43)
FLOORI G (6-15)
GLAZIN 4(C-17).
INSULA ON (C-2)
SEWAGE DISP. (C-42)
PAINTIN4 (C-33)
CERAMI TILE (C-54)
CABINET (C-6)
FENCIN (C-13)
LANDSCAPING(C-27
POOL (a