05-3875 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA .92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
c0: _L 0 3875'
81300 LEGENDS WY
762-420-012- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
15200
Architect or Engi
Ta!t
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012 ,R
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
KIA
81300 LEGENDS WAY
LA QUINTA, CA 92253
Contractor:
PICASSO POOLS, INC
WCC: STATE FUND
WC: 1709395 12/01/05
CSLB: 810111 07/31/06
Date: 9/02/05
-------------------------------------------------------------------------------------------------
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.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: License No.:
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Da tiS Contract
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
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 B C27 C53 Policy Number - - - - - - - - - - - - - - -
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 Code, I s all forthwith comply with those provisions.
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 ($5001.:
Dale% " S Applicant:
(_ 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
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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby madeto 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,
I—) 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, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit. -
Date: Owner:
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
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 for inspection purposes.
er's Name:
Lener's
e:—f-05ignature (Applicant or Age ..
LendAddress:
LQPERMIT
Application Number, .
. . . . 05-00003875
Permit
BLDG POOL PERMIT
Additional desc . . .
Permit Fee . . . .
171.00 Plan Check Fee
111.15
Issue Date
Valuation •. .
'15136
Expiration Date
3/01/06
Qty Unit Charge
Per.
Extension
BASE FEE
45.00
14.00 9.0000
----------------------------------------
THOU BLDG 2,001-25•,000
---------------------------------
126.00
Permit . . .
MECH POOL ,
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
- Valuation
0
Expiration Date
3/01/06
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
3/01/06
Qty Unit Charge-
Per
Extension
BASE FEE
15.00
1.00 30.0000
----------------------------------------------------------------------------
EA ELEC PRIVATE SWIMMING POOL
30.00
Permit .. . .
PLUMBING
Additional desc ..
Permit Fee . . .
33.00 Plan Check Fee
8.25
Issue Date
Valuation
0
Expiration Date
3/01/06
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
Permit . . . . . . WALL/FENCE PERMIT
LQPERMIT
LQPERMIT
Application Number . . . . . 05-00003875
Permit . . . WALL/FENCE PERMIT
Additional desc
-
Permit"Fee . . . . 15.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 64
Expiration Date 3/01/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
--------------------------------------------------------------
Special Notes and Comments
POOL & SPA ONLY. 4 L.F. 4' EQUIPMENT
BLOCK WALL, CITY STANDARD.
ALARMS/BARRIERS SHALL BE IN PLACE PRIOR
TO PRE -PLASTER INSPECTION.
Fee summary Charged Paid Credited
Due
~~ Permit Fee Total 290.00 .00
.00
290.00
Plan Check Total 137.15 .00
.00
137.15
Grand Total 427.15 '.00
.00
427.15
LQPERMIT
Iain # C1�y Lq Quin b
Bwl&d . &Safety Division
P.O. Boz 1.504, 78-s 9S. Calle Tampico .
Scitood.F'� I � .
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Total Permit+pots
f
4 1
Permit my
La Quirts, CA 51 3 - (760) 777-7012 '
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Telephone: _ -_ --- - - - < '<-::' CatLstrocrion l ype_ c?ca Fes':
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Stan Lie r: - -- - -- _ PT n Pe (eit cie one): Tvetr Add'n .Ait`r P --par. Demo
1�Iame!of Cotsact?etson: 5.9. FL: Stories I L`rits
Telepoanc �f C?ntaa Pinson: d �p�® mated Value ofProlC= 415 Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
I
R I
Submitral
I Rcq'd l
Rec'd
TiLaC JNG
PERF.fIT FEES
TUB Sets
)
Plan Check submitted I L(�
Item' I
:Amsunt
Strucuuml `'ales
I I
Reviewed. reach- for corrections I
Plan Check Dcpos�t
1
Truss Cale
I
ailed Contact Person.
Pian Check B-fanct
•Title 24 Cess
�
Plans picked up I
\
Construction
I
'Mood plaia Plan
I I
Plans resubmirt.d I
�tecbanical
IBrading
pan
I I
„ Rmim. rcadv for rorrcctionshssue -
Elcrtrieal
Subeon*mmr' List '
I
Called Contact Person I
Plumbic:
G'raat Deet?
Pians picked up
S_ti1_l.
H O �.AFProval
I
Plans resubmitted
Grading
'IN ACaUS__
i
I ''"-Review. readv for correetiottsfissue
Developer impact Fee
Pianming Approval
'i:
Called Contact Person
j
I .Pnb.Wlts kppr
I
Date of permit issue
Scitood.F'� I � .
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Total Permit+pots
f
4 1