05-4226 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-000.04.22.6
Property Address: 53865 AVENIDA CORTEZ
APN: 774-14'1-018-7 -000000-
Application description: POOL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 15000
Applicant:.
T-vf 4 4 Q"
Architect or En ginee
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty ofperjury that I am licensed under provisions:of Chapter (commencing with I
Section 7000) of Division 3 of the'Business and Professionals Code, and my License is in full force and effect.
License Class. . _ P, . r, r%irense'li --,%
voi&n 1-0 U-0 Contracta
OWNER -BUILDER DEC ON
I hereby affirm under penalty of perjury that I am exempt from the Comra 'sZtate License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, after, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to filei signed statement that he or she is licensed pursuant to the provisions the Contractor's State
Lim Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that hear she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 70314 by
anyapplicant for permit subjectsahe applicant to a:civil penalty of not more then five hundred dollars ($500).1
(_ 1 I, as owner of the property, or my'amployess 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 doesithe work himself or herself through his or her ownemployees, 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.).
C_ 1 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 orimproves thereon,.and who contracta,for the projects with a contractors) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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:
LQPSB11iIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9 / 21 /0 5
Owner:
DOUGLAS BIRDSELL
P.O. BOX 630
LA QUINTA, CA 92247
Contractor:
VICTORIA LANDSCAPES/WATERFALL
WCC: EVEREST NTNL
WC: 3.8.0002849 .08/26/06
CSLB: 801813 12/31/05
---------------------------------------------
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 self4risure for workers' compensation, as provided
for by Section 3700 of the Labor Code, Jor 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 whichthispermit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier C27 C53Policy 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 A kl becomes ttect.to the workers' compensation provisions of Section -
- 3700 of the La Co , I hall' fortl wT h comply with t�nia.
Date: --L 0<�APplica
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COV AGE 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 3708 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 Quints, its officers, agents and employees for any act oromission related to the work being
performed under or'foliowing issuance of this permit.
2. Any permit issued as a result of this application becomes null and void H 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 Kding construction, iKhereby authorize reqAVentatives
-of this county to enter upon the above-mentioned, Tins
Date: 2,71611 ignature,(Applicant or Ag
Application. Number . . . . . 05-00004226
A
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 162.00 Plan Check Fee 105.30
Issue Date . . . Valuation . . . . 15000
Expiration Date . . 3/20/06
Qty Unit Charge Per Extension
BASE FEE 45.00
13.00 9.0000 THOU BLDG 2,601-25,000 117.00
------------------------------------------------------------------------
Permit . . . MECH POOL
• Additional desc . .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . Valuation . . . . 0
Expiration Date . . 3/20/06'
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE >100K 11.00
---------------------------------------------------------------------
PermitELEC POOL PERMIT=RES
Additional desc . .
Permit Fee . . . 45.00 Plan Check Fee 11.25
Issue Date . . . Valuation_ . . . . 0
Expiration Date . . 3/2:0./06
Qty Unit Charge Per Extension.
BASE FEE 15.00
1.00 30.0.000 EA ELEC PRIVATE SWIMMING POOL 30.00
------------------------------------------------------------------------------
PermitPLUMBING
Additional desc . .
Permit Fee . . . 3.3.00 Plan Check Fee" 8.25
Issue Date . . . Valuation 0
Expiration Date . . 3/20/06
Qty Unit Charge Per Extension
BASE FEE 15.00
2.00 6.0000 EA P"LB 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
Application Number . . . 05-00004226
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-------------------------------- ---------------------------------
Special Notes and Comments
Special
-----------------------
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid
Credited
Due
Permit Fee Total 266.00 .00
.00
266.00
Plan Check Total 131.30 .00
.00
131.30
Grand Total 397.30 .00
.00
397.30
cQPERM r
Sep 27 05 02:OOp Victoria L&W 17607750449 1P.3
ic
Y-
#
City of La Quinta
Building at Safety Division
P.O. Box 1504, 78.495 Cape. Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Pernut 0
Project Addrrss.- 5.3 - S(f, J CSC f AV --Z.
O-ncr%Name'3oC, el ease -t l
A. P. Number
Address: S [-\-\Ie
LCO Description:
gym. s,: Zip: La Q. V v4zi . C A C1725?
Contractorv-10�+ala. �, 1 cls Irk
FTelephone:
_
=•iii ,
Address:. 2 - S- 1 . l U 3�k i G` F
Project Description:
CItr. ST. Zix l li O
i, �
Telepboreo:�j {pli .11 _ O 4 L)'`;
_
State Lie: d :
City Lic. #:u (D 3
Arch., Engr., Designer.
Address:
C-tty. ST. Zip:
Telepbone:.. * -+'' ='r4
State Lic. 8: 4� 3~ 1; `
-
Warne of Contact Person: y OlC2 l V-'
construction Type: Occupancy:
Projea type (eirck one): Near Add'n Alter Repair Demo
S4. Ft.: / Stories: M Units•.
Telephone _# of Contact Person; -7 t'q q 9 ,. .mated Value of Project:
APPUCANT: DO HOT WRITE BELOW THIS UNE
It
SnbraitUtl
Req'd
Reed
TRACKING PERMIT FEES
Plea Sets
Plan CbecL submitted
Item Amount
Structural Cala:-
:: -
"ReviewreA:'ready*6r corrections
Me Check Deposit — -- -
Truss Cala.
Called Contact Person
Pisa Check Balance
Energy Gla.
Pians picked up
Coastruetioa
iFlood plain plan
Pbas resubmitted
1lieehsaicsII
Grading:plan
2'4 Review, ready for eorrecliogsfissue
Electrical
SubeootaetorLtst
Called Contact Person
Plumbing
Gra at Deed
Plans picked up
SAA,
H O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review. ready for eorrectionsrrssae
Developer Impact Fee
Plaanlog Approval
Called ContaetTcrsoo
A.[.P.P.
Pub. Wk:_ Appr
Date of permit issue
'School Fees
Total Permit Fcei T-
RESIDENCE
53-865 AVENIDA CORTEZ LIG'
H T
LA QUINTAI CA. 92253 fj�kll'c
I G/E I
20'0
TWO CAR
GARAGE
DRIVEWAY
PATIO
—5101----.
910
1510
PLANTER
SEAT - AREA
V .400 st
decking
gate //l 3 18'6
4'4—;
I Uilio--LEDGE
9" T.
PLANTER CAEA
I
...... ....... ............... ............................. -."
................................. .. ............................. PLANTER
AREA 11'0
I E W WALL 5' MIN. 12' setback
APPROACH I to WWI
STREET
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DAM " Aj [Of
Victoria Landscapes 64 w mcf-lulla
82-365 Hwy. 111, Suitc 104
Indio, Ca 92201
Contractors Lic #801813