05-3880 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
05'-00003880
80789 BELLERIVE
775-360-025- -
POOL - RESIDENTIAL
LOW DENSITY RESIDE
30000
T4 -14t - 4 4 0".
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
D d a Owner:
JOHNSON
- 80-789 BELLERIVE
�r //�� C LA QUINTA, CA 92253
I L 1�EP lJ % DOJ
T1'OF�Q� UI q
FINANCE pEpT -
Architect or Engineer:
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: Contractoj'
✓/ OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).:
(_) 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 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.).
1 _ I 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.).
( ) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:
VICTORIA LANDSCAPES/WATERFALL.
WCC: EVEREST NTNL
WC: 380002849 08/26/06
CSLB: 801813 12/31/05
Date: 9/07/05
WORKER'S 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 issued. My workers' compensation
insurance carrier and policy number are:
Carrier C27 C53 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 'hat,
d
if I s d become subj to the workers' compensation provisions of Section
✓/ /370--0 of the Lab e, I shall fortbhw [h c m with those Cions.
Date: W App ant.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER S 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.
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 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 bt icg constructio nd hereby authorize representatives
of this cou ty po enter upon the above-mentioned pr,
r y'for inspe ti ur oses.
Date I Signature (Applicant or Agen
Application Number . . . . . 05-00003880
Permit .. . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee
284.50 Plan Check Fee
184.93
Issue Date . . . .
Valuation . . .
. 30000
Expiration Date
3/06/06
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 . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration.Date . .
3/06/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
----------------------------------------------------------------------------
EA MECH FURNACE >100K
11.00
Permit . . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
3/06/06
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 . . . .
33.00 Plan Check Fee
8.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
3/06/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 6.000O.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
LQPERMIT
Application Number . . . . . 05-00003880
-----------------------------------------------------7----------------------
Special Notes and Comments
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 388.50 .00 .00 388.50
Plan Check Total 210.93 .00 .00 210.93
Grand Total 599.43 .00 .00 599.43
LQPERMIT
Bin #
Permit #
0
Project Address: ejul I (D I
A. P. Number.
Legal Dtscription: 6;
Contractor. i.i.- . ]-oritt
jC AddrtssL),C/
S; ii
City, ST, Zip: '- 0
_
11, kYi-
Telephone;
State Lic. # P-1 1 -21
Arch, Engr- Designer.
City of La Quinta
Building & S*Ey Division
P.O. box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
40%vner'sNarne: I I arnf C
� I t i- � \re—. -7
XAddress:
'r7 KCity. ST. Zip: Lal k.','
FTelephone:
r• GC' -01
1XProject Description: t)0
_7 C, I
City Lic. #:
Total Permit Fees
Mjj elJOIDTA C,160:b0 90 TO Jes
Address:
'112- G4-A� UP
City, ST. Zip: 12-41e
r az-'
Telephone-
State Lic. 9: -
-01-5
Construction Type: Occupancy:
ter Repair Demo
Project (circle one): New Add'n Al'
Name of Contact Pcrson:
Sq. Ft:
0 Stories:
0 Units:
Telephone #of Contact Person:
imalcd Value of Project:
APPLICANT; DO NOT WRITE BELOW THIS LINE
N
Submittal
Rcq'd
Rcc'd
TRACKING PERMIT FEES
Plan Sets
Plan Check- submitted
Item Amount
Structural Cal".
Pl2m Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mcch3fliC21
Grading plan
2" Review, ready for corrections/issue
Electrical
Sub,contactor List
Called Contact Person
Piumizing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review. ready for correctionsfissut
Developer Impact FCC
Planning Approval
Called Contact Person
A. I.P.P.
Pub.%Vks. Appr
Date of Permit issue
School FCC$
Total Permit Fees
Mjj elJOIDTA C,160:b0 90 TO Jes
FAIRWAYS ASSOCIATION
September 1, 2005
Mr. Larry Johnson
Re: 80-789 Betlerivc
Arcbitectural/Landscape Application
Dcar Mt.-Johmon:
At the August 29', 2005, Architectural/Landscape Committee meeting the coiwrm ttee
reviewed and approved your plans as submitted with the following note: the BBQ may be no
higher than 48" from grade.
If you should have any questions, please do not hesitate to contact the at any time.
Sincerely,
Nancy C. arldn CLAM, CMCA
Operations anager
For the Architectural/Landscape Committee
Cc:
Post Office Box 1690 - La. Quints, California 92247 -Phone (760) 776-5100 - Fax (760) 776-5111.
0
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Victoria Landscapes & Waterfalls
82-365 Hwy.111, Suite 104
Indio, Ca 92201
Contractors Lic #801813
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BUIL & SAFETY DEPT.
- APPROVED
FOR C NSTRUCTION
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82-365 Hwy.111, Suite 104
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BUIL & SAFETY DEPT.
- APPROVED
FOR C NSTRUCTION
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