RPL (05-2909)1 —�
P.O. BOX 1504
18-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Propert ning:
1c ttFv, valuation:
'5700002909
81235 -NATIONAL DR'
767-S00-011- -
POOL - RESIDENTIAL
.LOW DENSITY RESIDENTIAL
20000
4 -
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Apnbcar 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.
Lice se Class: icense No.:
1
" Date:?*_C!5 Contractor:
WNER-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 1$5001.:
(_ 1 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.).
(_) 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
1 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:
LQPERMIT
Owner:
'FOSTER, MIKE
81-235 NATIONAL DRIVE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153 .
Date: 7/13/05
Contractor:
PICASSO POOLS, INC
WCC: STATE FUND
WC: 1709395 12/01/05
CSLB: 810111 07/31/06
-
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WORKER'S COMPENSATION DECLARATION
1 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.
Y 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 B 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 that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Co ,-1 shall forthwith omply with those provisions.
tD6e: Applicant: /� !9 .
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.
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 aresult 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 permitissued 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 building construction, and hereby authorize representatives
of this c my to enter upon the above-mentioned prop y for i coon purpose
S
Da Signature (Applicant or Age
LQPER IIT
Permit
MECH POOL
Additional
desc'
Permit Fee26.00
Plan Check Fee
6.50
Issue Date
. . . Valuation
0
Expiration
Date 1/09/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00
11.0000 EA MECH FURNACE >100R
11.00
Permit
ELEC POOL PERMIT -RES
Additional
desc .
Permit Fee
45.00 Plan Check Fee
11.25
issue Date
Valuation . . .
. 0,
Expiration
Date 1/09/06
Qty -Unit Charge Per
Extension
BASE FEE
15.00
1.00
----------------------------------------------------------------------------
X30.0000 EA ELEC PRIVATE SWIMMING POOL
30.00
Permit
. . . PLUMBING
Additional
desc .
Permit Fee
. . . . 33.00 Plan Check Pee
8.25
Issue. Date
Valuation. .. . .
. . 0
Expiration
Date 1/09/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00
6.0000 EAPLB FIXTURE
12.0,0
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
LQPER IIT
Application Number 05.-00002909
----------- - - - - -- -------
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 311.00
-- - - - - --
.00
---- - - - - - - I-
.00
- - - - - - - --
311.00
Plan Check.Total 160..55
.00
.00
160.55
Grand Total 471.55
.00
.00
471.55
L
LQPERMIT _
,'
Bin #
�C
.
.4
�C
Permit #
os- , qo9
Project Address: 8 - 1
A. P. Number-
tmtberLegal.
Legal.Description:.
Contractor.'
Units:
Address:
J
City. ST. Zip: l
Telephone:
State Lir— R:
Arch_ Eng:.. Desi -Ener'
Address
Citv.*ST. Zip:
Telephone:
State Lic. r:
Name?of Contact -Person:
Telephone : of Contact Person: -
Submittal Req'd
'Plan Sets
Structural Calcs.
Truss Calcs.
Titte'_d Cates.
flood
in plan
.Grading plan
Subeontactor List
'Grant Deed
H:O.A. Approval
IN HOUSE: -
'Planning Approval
,Pub. Wks. Appr
School Fees
City of La Quin.ta
. Building st Safery Division
P.O. Boz 1504, 78-495.CaDe Tampico.
La .Quinta, CA 92253 - (760) 777-7012
Building Permit Application and
/��Trackin, Sheet
11'r 1 r 0 %«ten's Name: f /i� /'f�DY
City. ST. Zip:
Lo �b 5 elephore:
V) � '! P1 � Project Description:
Lic. f:
Ep
. (I II 1 1 Total Permit Fees
cti n Dccu anc�•:
Constru o Type: c: P
xx .'P
- - Project npe (circle one): Nnv Add'n Alter Repair Dcmo
Sq. FL: Stories: 7
Units:
Estimated Value of Project: - �W
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rec'd
TR-kCKING
PERMIT FEES
Plan Check submitted
ps
Item
Amount
Reviewed. ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2' Review. readv for correctionsrtssue
��;
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
'Plans resubmitted
Grading .
"'Review. ready for corrections<ssue
Developer Impart Fee
Called Contact Person
A.I.P.P.
Date or permit issue
. (I II 1 1 Total Permit Fees
',
i� i I i � _- _ .____ _ _ -_ _ - �T -� _ _ . - � _ --------m--�--- - - - i I i
III, I II