05-0658 (RPL)t
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICOFAX (760) 777-7011
LA QUINTA, CALIFORNIA 9223;-3 1 iSPE'CTI�(j4N,,I g- Q,UES.TS-:(9.6U) '77;7; 7153
BUILDING PtRMIT
Application Number . . . . . 05-00000658 Date 2/24/05
Property Address . . . . . . 49045 CALLE FLORA
APN: 658-210-007- - -
Application description POOL - RESIDENTIAL
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 15000
C
Owner Contractor
10
NAGELBERG JEFFREY
126 N RIDGE ST
RYE BROOK
,-----------:.--- -N
'DESERT PARADISE POOL & SPAS
104 CALLE LOS HIBISCOS
PALM DESERT CA 92260
(760) 836-0368 -
WCC: STATE FUND
WC: 614360-2004 11/01/05
CSL=: 419309
12/31/06
CCC: C53
C27
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Permit .
. . . . .
BLDG POOL PERMIT
Additional
desc . .
Permit Fee
. . . .
162.00 Plan Check
Fee
105.30
Issue Date
. . . .
Valuation
. . . .
15000
Qty
Unit Charge
Per
Extension
BASE FEE
45.00
13.00
9.0000
BLDG 2_,,,yl-25,000.
O�1LU.1
117. 00
---------------------------
Rtr,
R,T. ..I
----- ------------------------
---------
________Permit
Permit .
. . . . .
MECH POOL
Additional
desc . .
Permit Fee
r 24•.-100 P it :n C4ec-k
Fee ^c-=?�t�• 6.00
Issue Date
Ail °fda2uation'
0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
1.00
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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
. . . .
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
P.O. Box 1504�� VOICE (760) 777-7012
78-495 CALLE TAMPICO Ta(f 4 4 FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: US— (0 SW Date: ' 2 S - 0-r
Applicant X12 _1_ PArchitect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
Co tyICAGTO/-c NA
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
bode, and my License in full force and effect.
icense Class HI��4 License No./C`
Daj d Contractor,/- 0
VV 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
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 Owner
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 maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
iss d. M orkerl' compensation insurance cameJ�dppli�y number are:
arrier 0 Fk wN d Policy Number- 4� ! �i 3 (► 0
certify that, in the performance of the work for which this permit is issued, 1 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.
aB to _'0 A;,plicant./
If
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION OVERAGE 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
Lender's Address / 1
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,
1 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 t'pectionpurposes.
te� /� Signature (Applicant or Agentw,�Jk;�
Page 2
Application
Number . . . . . 05-00000658
Date 2/24/05
Issue Date
. . . 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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Special Notes
and Comments
POOL & SPA.
ALARMS/BARRIERS SHALL BE IN
PLACE PRIOR
TO PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED IN
PERMIT.
Fee summary*
------------'------
Charged Paid Credited
Due
Permit Fee
------------------------------
Total 264.00 .00 .00
----------
264.00
Plan Check
Total 130.80 .00 .00
130.80
Grand Total
394.80 .00 .00
394.80
3
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N 65045'30" E 120.00'
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FOR CONSTRUCTION
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