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05-1503 (BLCK)' 4 i ----------------- BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION FAX (760) 777-7153 BUILDING PERMIT .Application Number, . . . . . .05-00001503 Date 4/21/05 Property Address 54260 WEST RESIDENCE CLUB DR APN: 775-380-999-4 -31627 - Application description WALL/FENCE Property Zoning . . . . . . . .MEDIUM DENSITY RES Application valuation 758 Owner Contractor NADADOR, LLC CALIFORNIA POOLS & SPAS 78120 CALLE ESTADO, SUITE 203 WCC: SEABRIGHT INS LA QUINTA, CA.92253. WC: BB1050510 01/01/06 CSLB: 65.6128 .10/31/06 CCC: C8 C27 C29 C53 ---------------------------------------------------------------------------- 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: S , �S©3 Date: `T- Z 2-0," Applicant: I Architect or Engineer: Applicant's Mailing Address: Co /v 7 -RA CT-or� Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS ICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensednder p visions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals / Code, and Lice i> II force and effect. d License Class ((/�. � L ens No._ �Ot/ ,4 2 LI �� Contractor _�l 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).): L) 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 Date 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. I have and will maintai workers' compensation insurance. as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is �+ ed. y worke compensation insurance came nd p lic ber ar //'� arrier Policy Number K;Nyb60 /Y fO I certify hat, 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 agre tha if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall _/ forthwith comply with those pro pro 'sions. .11ate 2v�QS Applicant✓ WARNING: FAILURE TO SECURE WORKERS' COMPEhSAiION 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 ATTORNEYS 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 q 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 app:icant, 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 th or ing performed under or following issuance of this permit. .2. Any permit issued as a result of this application becomes null and v d 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 o ct. I gree to comply with all city and county ordinances and state laws relating to building construction, and here y authorize representatives of this county t ter upon he o -mentioned property for inspection purposes. ears `— O signature// (Applicant or Agent). ---------------------------------------------7------------------------------ Application Number . . . . 05-00001503 ----------------------------------------------------------=-----=----------- Permit . . . . . . WALL/FENCE PERMIT Additional desc Permit Fee . . . . 21.00 Plan Check Fee .00 Issue Date Valuation . . . . 758 Expiration Date 10/18/05 Qty Unit Charge Per. Extension BASE FEE 15.00 3.00 2.0000.HND, BLDG 501-2,000 ------------------------------ 6.00 ---------------------------------------------- Special Notes and Comments 35 L.F. 5' BLOCK WALL, CITY STANDARD. Fee summary Charged Paid ----------------- Credited Due -------------------- Permit Fee Total 21.00 ---------- .00 ---------- .00 21.00 Plan Check Total .00 .00 .00 00 Grand Total 21.00 .00 .00 21.00 9 Bin # City Of La Quints Building sr Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # �-v3 05-, 1 . Project Address: – Z-(, �S Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: Cil t!, Fo BOj- Telephone::sti;:>:>z:>.::>szs::'s'r•>>>::»::>;::> . Address: t7 Box C 0, Project Description: City, ST, Zip: Grading Telephone:✓�90`- ::::<:;• ............ AN HOUSE: State Lic. # : /at City Lic. #.- :Arch., Jrd Review, ready for corrections/issue Arch.,Engr., Designer: Developer Impact Fee Address: r��—/ rr f`Q�K �L� Cl/ ✓�' �!� City, ST, Zip: Telephone: ne: Called Contact Person Construction on T YPOccupancy: A.I.P.P. State Lic. #: Project a circle ne : e to e J type o N Add'n Alter Repair Demo Pi ) P Name of Contact Person: Z11050W, Sq. Ft : #Stories: _T# Units:. Telephone # of Contact Person: Estimated Value of Project:. ©© APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'd Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Total Permit Fees Grant Deed Plans picked up S.M.L. H.O.A. Approval Plans resubmitted Grading AN HOUSE: Jrd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees