RPL (05-2908)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
i
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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.
License Class: License No.:
Ddfe:f Contracto
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that) 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).:
1 _ 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.).
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 or improves thereon, and who contracts for the projects with a contractor(sl licensed
pursuant to the Contractors' State License Law.).
I—) 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
VOICEi(760) 777 -7012. --
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/13/05
12/01/05
07/31/06
WORKER'S COMPENSATION DECLARATION
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.
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 C , I shall forthwith comply with those provisions.
aB' te:� /`/ Applicam: _ ,b./ .71 .
'WARNING: FAILURE TO SECURE WORK ERS'leOMPENSATION 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 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.
1 certify that I have read this application and state that the bove information is correct. I agree to comply with all
city and co my ordinances and state laws relating to bu' ing construction, and hereby authorize representatives
of this my to enter upon the above-mentioned pro rty for inspection purposes.
Date: Signature (Applicant or Agent):
Application Number:
05�0000.2.908___::.
Owner:
Property Address:
81335 NATIONAL DR
FIELDS,
JESSE
APN: 767-570-003- - -
81-335 NATIONAL DRIVE
A lieat-on descr'ip4tl
I7ng
POOL - RESIDENTIAL
LA QUINTA, CA 92253
operty LOW DENSITY RESIDENTIAL
plicIrt valuatiow
20000
2;
Contractor:
J`Applicant:
Architect or Engineer:
PICASSO
POOLS, INC
WCC.:
STATE FUND
WC:
1709395
GTO
CSLB :
810111
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.
License Class: License No.:
Ddfe:f Contracto
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that) 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).:
1 _ 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.).
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 or improves thereon, and who contracts for the projects with a contractor(sl licensed
pursuant to the Contractors' State License Law.).
I—) 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
VOICEi(760) 777 -7012. --
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/13/05
12/01/05
07/31/06
WORKER'S COMPENSATION DECLARATION
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.
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 C , I shall forthwith comply with those provisions.
aB' te:� /`/ Applicam: _ ,b./ .71 .
'WARNING: FAILURE TO SECURE WORK ERS'leOMPENSATION 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 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.
1 certify that I have read this application and state that the bove information is correct. I agree to comply with all
city and co my ordinances and state laws relating to bu' ing construction, and hereby authorize representatives
of this my to enter upon the above-mentioned pro rty for inspection purposes.
Date: Signature (Applicant or Agent):
Application Number .
. . . . 05-00002908
Permit . . . . .
BLDG POOL PERMIT
Additional desc
.
Permit Fee
207.00Plan Check
Fee
134.55
Issue Date . . . .
Valuation
20000 -
Expiration Date
1/09/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
_ 18.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
162._00
-
Permit . . .
MECH POOL
Additional desc .
Permit Fee ... . .
26.00 Plan Check
Fee
6.50
' Issue Date . . . .
Valuation
0
. Expiration Date
1/09/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.0.0 11.0000
----.------------------------------------------------------------------------
EA MECH FURNACE >100K
11.00
Permit . . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee
15.00_ Plan Check
Fee
3.75
Issue Date
Valuation
0
Expiration Date
1/09/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
Permit:-
PLUMBING
Additional desc .
Permit Fee . . . .
33.00 Plan Check
Fee
8.25
Issue Date •.
Valuation
. . . .
0
Expiration Date
1/09/06
=
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
----------------------------------------------------"-------
Special Notes and Comments
----
.
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
BE IN PLACE PRIOR TO
PRE -PLASTER
LQPERMIT
LQPERMIT
P.pplicdtion Number . . . . .
05-00002908
----------------------------------------------------------------------------
Special Notes and Comments
INSPECTION. EQUIPMENT ENCLOSURE
NOT
INCLUDED IN PERMIT.
Fee summary Charged
Paid
Credited
Due
Permit Fee Total 281.00
.00
.00
281.00
Plan Check Total 153.05
.00
.00
153.05
Grand Total 434.05
.00
.00
434.05
i
LQPERMIT
Bin #
X
Permit #
Project Addr-_ss: I
A. P. Number:
�C
a
-
Legal. Description:.
Contractor. j L
PERMIT FEES
City. ST, Zip: �rm ;.
Telephone: S4S—.q C` o U
' State Lic. # :
Arch. Eng;.. Designer
Address_
City. ST. Zip:
ei hone:
T ep .
State Lic. n:
Name;of Contact Person:
-#I '- of Contact Person: -
Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 C21cs.
Floodplain plan
.Grading plan
Subcontactor List
'Grant Deed
H:O.A. Approval
'IN -HOU E:-
'Planming Approval
Pub. Wks. Appr
Schon]' F es
I
City of La QuIn.ta
Building &r Safery Division
P.O. Boz 1504, 78-4 95. Calle Tampico .
La Quinra, a 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
CAJ I I-mer's Name:
7Address:. S Lj V
it}•. ST. Zip: \
elephone:
I r t ,n Project Description: � � R J
City Lic. r:
5310.
Total Permit Fees
0o
Consttvai n T .. c: Occupancy:
-�" Add'n Altrr Repair Dcmo
Project type (circle one): Ney
--T$q. FL: - Stories: Unit/s::
Estimated Value of Proiect: V 000
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rec'd
TRACKING
PERMIT FEES
Plan Check submitted I
(7112.1C9
Item
Amount
Reviewed. ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up (
C:tinstruction
Plans resubmitted
Mechanical
?" Review. ready for correctionsAssue
r
Electrical
Called Contact Pelson
Plumbing
Plans picked up
S!►I.I.
'Plans resubmitted
Grading .
`Review. read• for corrections/issue
.__
Deve-1m�pr- !_ tnnact Frr
Called Contact Person
A.I.P.P.
Date or permit issue
Total Permit Fees
0o
� Fl,