05-3873 (RPL)P.O. BOX 1504
78-495'CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 0.5-00003.873
Property Address: 797:92 HEMINGS WY
APW 604-520=019-19 -24197
Application description: POOL -_ RESIDENTI.AL
Property Zoning: LOW DNSITY RESIDENTIA
Application valuation: 33175
.Applicant:, Architect or
c&ht
BUILDING & SAFETY`DEPARTMENT
BUILDING PERMIT'
RFP A 7 1005
X_
A,11
LICENSED CONTRACTOR'S DECLARATION
I hereby:affirm under penalty'of'parjury°that I am licensedunderprovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of tTie Business.an ionals,Cade; and my License is in full force and..effect:
License lass: _ _ License No::
e. �'7- _ Contractor• � � � --
OW NER�BUILDER, DECLARATION
I herebyjaffirm underpagelty^of-perjury that i am axempt'from=the Contractor's State License Law for the
following reason ,(Seo, 7031.5; Business and,profeasions Code: Any city or county that,requires a permitto
construct,. alter; improve, demolish, orrepairany structure, prior to its issuenca,.;also requires the applicant for the.
permit:to file:a signed statement that he.orshe is licensed pursuant to the provisions of, the Contractors State
License Lew (Chapter 9 (commencing with .Section 7000) of Division 3 of the, Business and Professions Code) or
that he or she is exempt therefromand the'basis for'the alleged exemption: Any violation of Section 7031 A by
any applicant for apermaaubfects the applicant to a civil penalty 'of'not more than.five.hundred dollars (8500).:
I, as owner of the property, or, my amptoyees:witb wages as;their;sole compensation, will do,the work; and
the structure isnot intended or offered ,for sale (Sea :7044, Business andProfessions Code: The
Contractors' State License Law does';rwt apply to an owner of property who.builds.or improves -thereon,
and who.does thework himself or herseitthrough his:or her own employees; provided`tfiat.fha
improvementsare,notintended.oroffered'for-sale. If, however„the building or improvement is:sold within
one year'oPcompletion, the owner -builder will have the burden of proving that he'-orshe did, not build or
improvefor"the purpose of sate.).
of
1 _) ii as ownerthe property, am exclusively contracting with licensed contractors to construct the project,(Sec.
7044,B
and. Professions Code: The Contractors' State License Law does notapplyto-an.owner of
property who builds or improves thereon, and who, contracts for the,projects with a.contractor(s) licensed
pursuarit'to,the Cgntractors' State License Law J.
(_) I;am exempt under Seca B.&P.C. for thisreason
Date: Owner:
CONSTRUCTION: LENDING AGENCY
I hereby affirm under. penalty of perjury that there is's construction, lending'.agency'for the performance of the
work.forwhich this permit is issued (Sec: 3097, Civ: C.)•
Lender's Name
Lender's Address:,
LQFJMMrr
VOICE (760) 777-7012
FAX (760) 777-701-1
INSPECTIONS (760) 777-7153
Dater 9/02/'05
Owner:
EYER
79-792'. HEMINGSWAY
LA QUINTA, CA 92253
Contractor:
GATTUSO POOL CORPORATION
WCC': STATE FUND
WC`t 16.15074 0,1/01/06
CSLB: .672'850 06/30/07
WORKER'S COMPENSATION DECLARATION
I:hereby affirm under penalty of perjuryane of:the fdlowing declarations:
I have:and will maintain,a certificate of'consern 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
Xissued.
t have an&will maintain workers' compensation insurance, as required by Section23700 of:the Labor
Code, forthe performance of the,work for which this permit.is issued. My workers' compensation
insurence_cainertand policy number. are:
Carrier C53 Policy Number '-------------
= I certify that, in the performance of the,work for which this parmit'is issued,:1 shall not employ,any
person in any manner so as to•become subjectfo,the workers' compensation, laws of California;
and agree that if„I'should beco W, cyto the workers compensation provisions of Section
/% 3700 of the Labor'Code I _ , rthwith comply with'those provisions:
aQ te: �j2C7ApplicaAt: - -
WARNING:, FAILURE TO URE:WORKERS'COMPENSAT,ION COVERAGE.IS UNLAWFUL, AND SHALL
SUBJECT°AN EINPL6YER O CRIMINAL PENALTIES AND CIVIL FINES UP TO:ONE HUNDRED THOUSAND
DOLLARSI$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.
APPuCANT'ACKNOW LEDOEMENT
IMPORTANT Application is hereby:made to the Director of Building_ and Safetyfora permit subject to the
conditions and restrictions set forth on this application..
1. Each
person uponwhose behalf this'.application is made, ,each person at whose,request erd;for
whose benefit work is performed under:orpursuaM to any permit issuad'asa result of this'apWication;
the owner, and the applicarrt, each agrees.to, and shall defend, indemnify and hold harmless the City
of La 0uinte, its officers, agentsan d employees for any,act or omission related tothe work:being
performed underbr following issuance -of this permk:
2. Any permit issued as a result of'this application becomes nud and void if work.is'not commenced'
within 180 days from date of Issuance of;such•permit, or cessatiomof work;for 180 days will subject
permit to,cancellation..
(certify that I have ,read 'this application and state that the abovelinformation .s correct. I,agree.to comply with all
city e - nrtyordinances.and state laws>relating to building constructi hereby authorize!representatives
of tpifcounty to enter upon.the above-mentioned property for ins rposes.
ate: Signature (Applicant or Agent):
r6
LQPE&Mff
Application Number . . . . . . 05-00003813
Permit . . . . . .
BLDG POOL PERMIT
Additional desc
Permit Fee . . . .
304.00 Plan Check
Pee
197.60
Issue Date
Valuation
. . .
. 32'935
Expiration Date
3/01/06
Qty. Unit Charge
Per
Extension
BASE FEE
252,.00
8.00 6.51000
---------- -------
THOU BLDG 25,001-50, OU
--------------
------------------
82.00
Permit . . . . . .
MECH POOL
Additional desc
Permit Fee,
26.010 Plan Check.
Fee
61.50
Issue Date . . . .
Valuation
6
Expiration 'ija:f-e . .
3/61/06
Qty Unit Charge
Per
Extension
BASE FEE
15,:0'0
1.00 11.0060
----------- ------ ------------------------------------------------------------
EA MECH FURNACE >10,OK
1L. 00
Permit. . .
ELEC POOL PERMIT.-RES.
Addit'i6nal,desc . ..
Permit Fee
45.00 Plan Check
Fee
11.25
Issue Date . . . .
Valuation
. . .
Ex 4
piration D te
3/01/06
Qty Unit Charge
Per
Extens , ion
BASE FEE
66,
1.00 3060000
EA ELEC.PRIVATE SWIMMING
--------------------------
POOL
.,30.0,0
Permit . . . . . .
PLUMBING
Additional desc . .
Permit it Fee
33.00 Plan Check
Fee
8.25
-
Issue Date . . . .
Valuation
0
Expiration Date
3/101/06
Qty Unit Charge
Per
Extension
BASZFEE
15.0:0
2.00 6.0000
EA PLB FIXTURE'
12.00
1.00 3.0000
EA PLB WATEkINST/ALT/REP
3.00
1.00 3-0000
EA PLB GAS PIPE -1-4 OUTLETS
----------- 1---- -------------
3.0:0
I --------
Permit . . . . . . WALL/FENCE PERMIT
Application Number . . . . . 05-00003873
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 15.00 Plan Check Fee .00
Issue Date . . . Valuation . . . . 240
Expiration Date 3,/01/06
Qty Unit Charge Per Extension
BASE FEE 15.00
------------------------------------------------------- ----
Special Notes and Comments
POOL ,& SPA ONLY. 15 L.F. 4' EQUIPMENT
BLOCK WALL, ORCO SYSTEM.
ALARMS/BARRIERS SHALL BE IN PLACE PRIOR
TO PRE PLASTER INSPECTION.
Fee summary Charged Paid Credited Due
----------------------------------------
Permit ----------
Fee Total 4`23.00 .00 .•00 423...00
Plan Check Total 22.3.60 .66 .00 223.60
Grand Total 646.60 .0.0 .00 646.60
09/02/'2005 09:48 1784.920 GATTUSO POOL CORPORT
CITY OF LA QUINTA
BUILDING & SAFETY DEPT..
APPROVED
FOR CONSTRUCTION_
DATE' ! f OS BY
PAGE 02
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09/02/2005 09:48 1784920 G4TTUSOPOOL CORPORT PAGE 01
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City of La Quinta
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La QuInca, CA 92253
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