05-2305 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00002305
Property Address:
80435 CAMARILLO WY
APN:
772-250-997-116 -31349 -
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
15000
Applicant:
T41�v 4 4 Qu&m
or Engineer:
k
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 icense is in full force and effect.
✓✓✓ License CI ss: � ! �,Q License No.:
✓ Date: O Contractor: ��-(A.�ti
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 _ ) 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 _ 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(s) licensed
pursuant to the Contractors' State License Law.).
(_) 1 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:
TASTO
80-435 CAMARILLO WAY
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: 6/13/05
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.
X 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 PolicyNumber"`-----------
_ 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 Cocke, I shall forthwith �c'om�ply_with thos pro
tW105-Applicant: ®I`XQ
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 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 issuanceof 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to buil 'ng construction, and hereby authorize representatives
of t/his,2u`nty to enter upon the above-mentioned prope ori specuon purposes.
D to e: l� Signature (Applicant or Agent): ��
Application Number . . . . . 05-00002305
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 162.00 Plan Check Fee 105.30
Issue Date . . . . Valuation . . . . 15000'
Expiration Date . . 12/10/05
Qty Unit Charge Per Extension
BASE FEE 45.00
13.00 9.0000 THOU BLDG 2,001-25,000 117.00
------------------------------------------------------------- --------------
Permit . . . MECH POOL
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date 12/10/05
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 . . 12/10/05
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
------------------------------------- I
. . . PLUMBING
Additional desc .
Permit. Fee . . . . 33.00 Plan Check Fee 8.25
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 12/10/05
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
LQPERNIIT
Application
Number . . . . . 05-00002305
----------------------------------------------------------------------------
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 266.00 .00
.00
266.00
Plan Check
Total 131.30 .00
.00
131 -.30 -
Grand Total
397.30 .00
.00
397.30
LQPERHIIT
Bin t,9
.0ty of Lg Quin
Bdi ring. if Safety Division
P.O. Boz 1.504, 78-1-Y5. Cafle Tampico .
Permit n Ia QWnm, CA 92ti3 - (760) 777-7012
QS- Building Permit Application and Tracking- Shee •
Prc, = Addx-=: �mm's Tame.
v n
A. P Address;
Legal Description:
Cin . ST. Zip: - -
-
Cott McMr'Pip*
, eicphone: �
pddrc=-880x1
Projectt Description:
Cite. St. Zip
Telephone:
State Lie 4B 01 `
.Ajtii-Emg_ Designer.
I Citi' Lic.
Addre=
City. ST- Zip:
Tei_ hone:
Stasi LieProje`t
_ _ _ _ _
Construction Type: Occt:pznc
Type (circle one): lvrty Add'n AIL --r Rep2ir Dano
Tameiof-Conma Person:
$q. Fc: Stories: : Urim
' -Telephone # of Contact Person:
-14 to®®
rstirn=ed Value of Pmiect:
APPUCANT: DO NOT WRITE BELOW THIS LIME
Snbmittai I
Req'd I
Rev'd
TRACKING I
Fc -MITT FEFS
ZI
Plan Sets (
+
Pan Check submitted
I
Y/'Q
Item (
Am cunt
Strnenural Calcs. I
I
Reviewed ready for corrections I
Plan Check Depose
"Truss C21M
Called Contact Person.
Pian Check Balanct
-Title =4 Cates
Plans picked up
I
Construction
Tlbod plain plan
I
Plans resubmit -[_d
I
Mechanical
Gradin, pian I
'_'" Ret-iew. readv for correctionsTtssue
Electrical
Subeontaetor List
I
Called Contact Person
Plumbing
Gram Deed
Plans picked up
S_M11.1.
ILO-A..Approval
+
Plans resubmincd
,
Grading
'1'V HOUSE:-
I
"Review. read• for correctionVissue
Developer Impar Fer
'Planming Approval '.
I
Called Contact Person
A.1-P.P.
•Pub. M& Appr
I
Datc of permit issue
11 SchooLF'ees
I
Total Permit Fecs