06-2269 (SOTB)0
P.O. BOX 1504
78-495 CALLE TAMPICO JUN 07 f
LA QUINTA, CALIFORNIA 92253
CITY OF LA QUINTA
Application Number:
06-00002269
Property Address:
80375 POMELO
APN:
772-250-022-188 -30357 -
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
12000
Applicant: Architect or Engineer:
44"
SAFETY DEPARTMENT
DING PERMIT
Owner:
TOLL CA V
C/O KEVIN D DUERMIT
8901 E MOUNTAIN VIEW 200
SCOTTSDALE, AZ 85258
Contractor:
PICASSO POOLS, INC
78078 COUNTRY CLUB DR, #206
BERMUDA DUNES, CA 92201--0
(760)345-4600
LiC. No.: 810111
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/05/06
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.I.
Lender's Name:u/
Lender's Address:
LQPERMIT
g p ogees oy g
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 county to enter upon the above-mentioned property fo n purpose '
Date4 -Y Signature (Applicant or Agent): �� 1
------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
--
----------------------------------------------—
WORKER'S COMPENSATION DECLARATION ,
I hereby affirm under penalty of perjury that I am licensed 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 Professionals Code, and my License is in full force and effect.
_ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B C27 C53 cense No.: 810111
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. '
Date•l Contractor:'
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
V/ I ,
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 1709395.
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Cod orthwitemp y with those provisions.
that he or she is exempt therefrom•and the basis for. the alleged exemption. Any violation of Section 7031.5 by
-_.. .s ... -
" any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date �•� " Applicant: �►✓
(_) 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF'THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT '
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an'owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
-whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
•
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta its officers a ents and em I for an act or omission related to the work bein
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.I.
Lender's Name:u/
Lender's Address:
LQPERMIT
g p ogees oy g
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 county to enter upon the above-mentioned property fo n purpose '
Date4 -Y Signature (Applicant or Agent): �� 1
LQPERn4IT
Application Number . . . . . 06-00002269
Permit . . . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 135.00
Plan Check
Fee
87.75
Issue Date . . . .
Valuation
. . .
. 12000
Expiration Date 12/02/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
10.00 9.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
90.00
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 33.50
Plan Check
Fee
8.38
Issue Date . . . .
Valuation
0
Expiration Date 12/02/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 18.5000 EA• ELEC SVC <=600V/<=200A
----------------------------------------------------------------------------
18.50
Permit . . . PLUMBING
Additional desc .
Permit Fee 24.00
Plan Check
Fee
6.00 .
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 12/02/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 6.0000 EA PLB FIXTURE
6.00
1:00 3.0000 EA- PLB WATER INST/ALT/REP
-------------------------------=--------------------------------------------
3.00
Permit . . . WALL/FENCE PERMIT
INV FEE
Additional desc .
Permit -Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date . . .
Valuation
64
Expiration Date 12/02/06
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
FOUNTAIN WITH 4 LF. 4' HIGH BLOCK WALL
CITY STANDARD
Fee summary Charged Paid
Credited
Due
LQPERn4IT
Application Number . . . . . 06-00002269
Permit Fee Total 222.50 .00 .00 .222.50
Plan Check Total 102.13 .00 .00 102.13
Grand Total 324.63 .00. .00 324.63
LQPERMIT
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