04-5159 (RPL)T4hf 4 4 Q"
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 a. (760).777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number .
Property Address . . . .
APN:
Application description
Property Zoning . . . .
Application valuation
0--4--0000,51:59--� 'Date = ` 8/19/04
52720'AVENIDA VALLEJO
773-293-011-13 -000000-
POOL - RESIDENTIAL
COVE RESIDENTIAL
12000
Qty 'Unit Charge Per
AlG -9 3 2004 IM ,
CITY OF LA QUINTA
Extension
Owner
Contractor
POWER FINANCE
PICAZO POOLS & SPAS
P.O.'BOX 134
82365 HIGHWAY 111,
SUITE #101
LA QUINTA
CA 92253
INDIO
CA 92201
(760) 347-5855
WCC: EXEMPT
WC: EXEMPT
05/31/05
CSLB: 836900
04/30/06
-----------
CCC: C53
-------------------------------------------------------
Permit. . . . .
. .
BLDG -POOL PERMIT
------ ---
Additional desc
Permit Fee
135.00
Plan Check Fee
87.75
Issue Date . .
. .
Valuation . . .
. 12000
Expiration Date
2/19/05
Qty Unit
Charge
Per.
Extension
BASE
FEE
45.00
10:00
9.0000
THOU BLDG
2,001-25,000
90.00
-----------=-------------7
-----------------------
;
Permit . . . .
. .
MECH POOL
--------------------
7 -------
Additional desc
Permit .Fee
24.00
Plan Check Fee
6.00
Issue Date
Valuation
0
Expiration Date
2/19/05
Qty Unit
Charge
Per
Extension
BASE
FEE
15.00
1.00
-------------------------------------------------------
9.0000
EA MECH
FURNACE <=100K
9.00
Permit .
. .
--------------------
ELEC POOL PERMIT -RES
Additional desc
Permit Fee . .
. .
45.00
Plan Check
Fee'.
11.25
Issue Date
Expiration Date
2/19/05
Valuation
IID)
0
Qty 'Unit Charge Per
AlG -9 3 2004 IM ,
CITY OF LA QUINTA
Extension
P.O. BOX 1504 •
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 04-6151 1 Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
0 /A
Lic. No.:
BUILDING PERMIT DECLARATIONS
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 Lic nse is in full force and effect. C,
/License Class - O, icense No.
' 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.).
U 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 I am exempt under Sec. , B.8 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
issued. My workers' compensation insurance carrier anis policy number are:
Carrier 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 Code, I shall
fQ� forthwith comply with those provisions.
Date /Applicant
WARNING: FAILURE TO SECURE WORKERS./-'
ORKERS' 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.
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, indemnify and hold harmless the City of La Ouinta, 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 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 u on the above-mentioned property for inspection purposes.
ate Z�.v -I nature (Applicant or Agent):
Page 2
Application Number . . . . . 04-00005159
Date 8/19/04
Qty Unit Charge Per
Extension
- BASE FEE
15.00
1.00 .30.0000 EA ELEC PRIVATE SWIMMING POOL
'30.00
----7-----------------------------------------------------------------------
Permit . . . PLUMBING
Additional desc
Permit Fee 27.00 Plan Check Fee
6.75
Issue Date Valuation . .
. . 0
Expiration Date . 2/19/05
Qty -Unit Charge Per
Extension
BASE FEE
15.00
1.00 6.0000 EA PLB FIXTURE
6.00
1:0'0 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 ONLY. ALARMS/BARRIERS SHALL BE IN,,
PLACE PRIOR TO PREPLASTER INSPECTION.
EQUIPMENT,ENCLOSURE NOT INCLUDED IN.
PERMIT.
Fee summary Charged Paid Credited
Due
Permit Fee Total 231.00 .00 .00
231.00
Plan Check Total 111..75 .00 .00
111.75
Grand Total 342.75 .00 .00
342.75
GEPERATE PEI rf MID MSPECTION. .
FFtCt'I CITY OF LA OLINTA PUBLIC 41-01-
WOMS DEPARIIIEW
A RE -INSPECTION FEE -OF $30.
CITY. OF LA Ql1IIVTA
WILL BE CHARGED IF THE APPROVED ✓, BUILDING & SAFETY DEPT.
PLANS AND JOB CARD ARE NOT ON / . PowmFWANCE, MSOCIMJE* AP ROVE®
F R ONSTRUC iON,
THE BITE FOR A SCHEDULED -G�-
r ' / �,
INSPECTION. l� �G
NO EXCEPTIONS! DATE BY
IN,
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GEPERATE PEI rf MID MSPECTION. .
FFtCt'I CITY OF LA OLINTA PUBLIC 41-01-
WOMS DEPARIIIEW
A RE -INSPECTION FEE -OF $30.
CITY. OF LA Ql1IIVTA
WILL BE CHARGED IF THE APPROVED ✓, BUILDING & SAFETY DEPT.
PLANS AND JOB CARD ARE NOT ON / . PowmFWANCE, MSOCIMJE* AP ROVE®
F R ONSTRUC iON,
THE BITE FOR A SCHEDULED -G�-
r ' / �,
INSPECTION. l� �G
NO EXCEPTIONS! DATE BY
IN,
CITY OF LA QUINU SUO-CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER OWNER BUILDER f lC,4Zo
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous l2lace. Only persons appearing on this list or their employees'are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result inastoppage of work and/or the voidance
of building permit.. For each applicable trade, all information requested below must be completed by applicant. `,"On File" is not an acceptable response.
Trade / Classification
Contractor
State Contractor's License�1lorkers
Com ensation Insurance
City Business License
Company Name
Classification .
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
A.i:�L®I
f"' 0
A i e
13
3 -
CONCRETE (C-8)
g A C - A 5
SIPIE., r-1.
!
��(c�
id -4/04
FRAMING (C-5)
STRUCT. STEEL (C-51)
rrAze-, e -o "i8 _ gwob
I✓'
C- 4A_�r(�
'
MASONRY (C-29)
PLUMBING (C-36)
IC -A M
L- S
90�
®&,
IffcA-Li
LATH, PLASTER (C-35)
�
4�'9�
DRYWALL (C-9)
HVAC (C-20)
ELECTRICAL (C-10)
.1 , Ak, 9AC-61,
CnI
5-0
- --
�
i
ROOFING (C-39)
SHEET METAL (C-43)
FLOORING (C-15)
GLAZING (C-17)•
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
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