12-0111 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:X12-00000111
Property Address: 52555 AVENIDA CARRANZA
APN: 773-285-015-2 -000000-
Application description: POOL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation:. 25000
Tityl
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MOLLER LISA
52555 AVENIDA CARRANZA
LA QUINTA, CA 92253
k O
Contractor:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/07/12
Applicant: Architect or Engineer: GATTUSO POOL CORPORAT ON
667 S. EUGENE ROAD
cl-Ty
PALM SPRINGS, CA 922644?fly• ---"
(760)327-7592
�I n_ Lic. No.: 672850
---------------------------------------------------------------------------------,----------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am Ii sed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and ofessionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C53 License No.: 672850 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
tractor: �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
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 1$500).:
1 _ 1 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 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, 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.).
(_ 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
insurance carrier and policy number are:
Carrier EVEREST NATL Policy Number 7600006501121
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 Ishould beco ubject to the workers' compensation provisions of Section
37700 of the Labor Code, I forthwith comply with those provisions.
,,dale:
`Applicant:
WARNING: FAILURE TO SECU WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). 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 1 have read this application and state that the above infor ion is correct. I agree to comply with all
city and county ordinances and state laws relating to building cons tion, and hereby authorize representatives
of this county to enter upon.the above-mentioned property for i action p es.
Date: C $ ature (Applicant or Agent):
Application Number . . . 12-00000111
Permit
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
252.00 Plan Check
Fee
163.80
Issue Date . . . .
Valuation
. . . .
25000
Expiration Date
8/05/12
Qty Unit Charge
Per
Extension
BASE FEE
45.00
23.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
207.00
Permit
MECH POOL
Additional desc .
Permit Fee . . . .
26:00 Plan Check
Fee
6.50
Issue Date
Valuation
. . . .
0
Expiration Date
8/05/12
Qty Unit Charge
Per
Extension
BASE .FEE
15.00
1.00 11.0000
----------------------------------------------------------------------------
EA. MECH FURNACE >100K
11.00
Permit
ELEC POOL PERMIT -RES
Additional desc .
Permit. Fee.
45.00 Plan Check
Fee
11.25
Issue Date
Valuation
0
Expiration Date
8/05/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
----------------------------------------------------------------------------
EA ELEC PRIVATE SWIMMING
POOL,
30.00
Permit .. . .
PLUMBING
Additional desc .
Permit Fee
33.00 Plan Check
Fee
8.25
Issue Date
Valuation
. . . .
.0
'Expiration Date
8/05/12
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
Permit . . . . . . WALL/FENCE PERMIT
LQPERMIT
Application Number 12-00000111
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 15.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
160
Expiration Date 8/05/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes and Comments
POOL/SPA, 10 L.F. 4' EQUIPMENT
ENCLOSURE; CITY STANDARD.
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------
Due
----------------- ---------- ---- -----
Permit Fee Total 371.00 .00
----------
.00
371.00
Plan. Check Total 189.80 .00
.00
189.80
Other Fee Total 1.00 .00
.00
1.00
Grand Total 561.80 .00
.00
561.80
LQPERMIT
CITY OF LA QUINTA.
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE -2 7 /Z BY (5 ,
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City of La QUiICIta
Building 8L Safety Division
P.O. Box 1504
Permit # ...,
78-495 Calle Tampico
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La Quinta, CA 92253
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Building Permit Application. and Tracking Sheet
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Arch.. Eng.. Designer. EL 10
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Address: 7 3 (0 (o
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Cit.'. ST. Zip: PAI -14 OV5teT CAL 2LUPO
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Telephone: 7 _ d 5
Construction Typc: Occupancy:
State Lic. =: 33
Project type (circle one): New Add'n Alter Repair
Demo
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