04-4838 (RPL)Tihf 4. 4 a9ha
BUILDING & SAFETY DEPARTMENT
.P.O. BOX 1504(760) 777-7012 .
78-495 CALLF TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number X04=0.0004838 Date 6/09/04
Property Address . . . . . . 44275 CAMINO AZUL
APN: ..604-191-016-36 -24517 -
Application description . . . POOL - RESIDENTIAL
.Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 15000
Owner Contractor
JANISCH ALAN PICASSO POOLS, INC
.44275 CAMINO AZUL 78078 COUNTRY CLUB DR, #206
LA QUINTA CA 92253 PALM DESERT CA 92211
(760) 345-4600
WCC: STATE FUND
WC: 1709395 12/01/04
CSLB: 81011 11/20/04
CCC: C27 -053 -B-
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27-053-B
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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 THOU BLDG 2,001-25,000 117.00
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Permit MECH POOL
Additional desc
Permit Fee . . . 24.00 Plan Check Fee 6.00
Issue Date . . . . Valuation . . 0
Qty Unit Charge Per Extension
BASE. FEE 15.00
1.00 9.0000 EA MECH FURNACE <=100K 9.00
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Permit . . . . . . ELEC POOL PERMIT -RES
Additional desc
Permit Fee . . . 45.00 an ec ee 11.25
Issue Date D 0
Qty Unit Charge Per JUN 11 2004 Extension
BASE 15.00
1.00 30.0000 EA... ELEC R 0$WA91XG -P OL 30.00
FINANCE DEPT.
P.O. Box 1504_ • VOICE (7601 77
79-495 CALLE TAMPICO FAX (760) 777-7pt ;
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-715
BUILDING 8 SAFETY DEPARTMENT
Application Number: 0q- 49318 Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engin is Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my . en ey5 in ill grcqant;ffect.
cense Class / LicenseNo.
4 n `
Date/ ractor 1 t( A00 Lo 4
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 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 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.).
( ) 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 t 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
w.Qrkers' compensation nce carrier and policy num r are:
er ST, IjA/d Policy Number
I certify that, in the performance of the work for whichhtf isTp_e_rrrrrfliit 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 Code, I shall
I th comply with those pr ions.
Date Applicant
WARNIN : F ILURE TO SECURE WORKERS' CO ENSATION 610VERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FI ES 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
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, indemnity and hold harmless the City of La Ouinta, its
officers, agents and employees for any act or omission related to the work being perforned 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 190 dayi from date of issuance of such pemmit or
cessation of work for 180 days will subject permit to cancellation.
I certify that I e rad this application and state that the above information is corecL I agree to comply with all city and county ordinances and state laws relating t0 building
construction, / d reby authorize representatives of this county to ter upon thea ntion property for inspection purposes.
IWte �/ ��// Signature (Applicant or Agent): '
r
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Page 2
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6/09/04
--Application-Number--� ------------------Date
Permit . . . . . . PLUMBING
---
Additional desc
Permit Fee . . . . 33.00 Plan Check Fee
8.25.
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 AT PRE -PLASTER INSPECTION. _
EQUIPMENT ENCLOSURE -NOT INCLUDED
Fee summary Charged Paid Credited
-----------------------------------------------
Due
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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
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