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SOTB (05-3554)02 `P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Tdy 40" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT X05=00003554 81275—NATIONAL DR 767-500-013- - - STRUCTURES OTHER THAN BUILDI LOW DENSITY RESIDENTIAL 2200 Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION ° D AUG 17 2005 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 lass: License No.: - Dated Contractor: CAWi6� 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, 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 town 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.). (_ 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: PECK 81-275 NATIONAL DRIVE LA QUINTA, CA 92253 Contractor: PICASSO POOLS, INC WCC: STATE FUND WC: 1709395 CSLB: 810111 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 12/01/05 07/31/06 Date: 8/11/05 ----------------------------------------------- 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.theperformance 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 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date Applicant: 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 1$ 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 building construction, and hereby authorize representatives of this c my to enter upon the above-mentioned propert ffor inspection poses. Date: �� Signature (Applicant orAge Application Number . . . . 05-00003554 Permit BUILDING PERMIT Additional desc . Permit Fee 54.00 Plan Check Fee 35.10 Issue Date . . . Valuation 2200 .Expiration Date 2/07/06 , Qty Unit Charge Per Extension BASE FEE. .45.00 1.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 9.00 Permit ELEC-MISCELLANEOUS Additional desc . Permit Fee . . . 16.35 Plan Check Fee 4.09 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/07/06 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 .4500 EA ELEC DEVICE/FIXTURE >20 1.35 Permit . . . PLUMBING Additional desc . ` Permit Fee . . . . 18.00 Plan Check Fee 4.50 Issue Date Valuation 0 Expiration Date 2/07/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ----------------------------------------------------------------=----------- Special Notes and Comments. BBQ #3020914. Other Fees . . . .. . -------------------------------------- . . . . ENERGY REVIEW FEE 3.51 Fee summary Charged ----------------- Paid Credited Due ---------- Permit Fee Fee Total ---------- 88.35 ----------------- .00 .00 88.35 Plan Check Total 43.69 .00 .00 43.69 Other Fee Total 3.51 .00 .00 3.51 Grand Total 135.55 .00 .00 135.55 LQPERMIT �Permk # 057 3 Proj= Mar= A- P. Nnnbts : LeQa1.D=cripdon. ICotnracor: �—t, Addrts-- JL City. ST. Zi .4 TelephoLD 5– 'Stag' Lic R : a Addr= City. S� Zia' . j Teiephenc:' I I State U.C. Nameiof Cotsact ?erson: 'Tel�mne of Cana Pinson: �1 y of % Quinb Bui1&z;. &r Safety Division P.O. Boz 1304, 78-495. C- Ae Tampim . La Quinra,-CA F=3 - (760) 777-7012 BLdldin; Permit Application and Tracking Sheer, �Addr=: Cin•. ST. Zip: 9 1 cicphonc: •- Pro ect Desai tioti- City Lic Consauction Type: Occt:.p -: Proje= type (circle one): Net Add'n Aitcr R.^pcir D=o $q. Ft_: r Stories: L'rits ®® Estimated Value orProie 545-4(,,00 APPLICANT: DO NOT WRITE BELOW THIS LINE R I Submittal Req'd ( Rm'd TRaC ING P r.IIT F� Plan Sets I I Plan Check submined I8 -/ Ds ]rein Amauat 5trsau21 Calm I I Reviewed. reach- for corrections I Plan Check Dcr.mit Truss C21r- I' Called Contract Person. , Plan Check Balance T•itle'_z Cass Plato picked up I So T& Construction ,ZOO :F7'ood alais plan ( I Plans resubmitted I Aiecaanieal -Gradin-, p -an ( I '_Rmim. rcadv for corrcctionsicsuc Elcrtrictl Subenatacier list ' I Called Contact Person I Plumbing �e5 OUTLET G'raat Des Plans picked up S_tii_I. ILO,A-.AFProval I "'Plans resubmitted I 'Grading 1N AC4uJs--- '"'-Review. ready for corremonvissue i Developer Impar Fcc -Planmin; Approval : CaIled Contact Person I TATF. F. I I.Pub. V'l:s Appr I Datc of permit issue -SC hooft L Total•Permiffcs f �' � _�_- r �_ _------ -- __ -- _- � ,� C � � � � �I I I �� I� i I I I