05-2572 (RPL)44 P.O BOX 1504 VOICE (760) 777-7012
78-495' CALLE TAMPICO FAX (760) 777-7011
-LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETYDEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
7 Date:, 6/24/05
Application Number. 05-00002572 Owner:
Property Address: 80 -3 -5 -0 -`VIA CASTELLANA +. SANDOVAL JOHN
APN:. 772-250=997-129 -31349 = .80-350 VIA CAS TELLANA
Application description: POOL'- RESIDENTIAL LA QUINTA, CA 92253
-Pr.operty Zoninq LOW DENSITY RESIDENTIAL
•
Application valuation: 15000 ® '
DContractor:
Applicant: Architect or E in er:[� PICASSO POOLS, INC
JUN 2 9 2005 WCC: STATE FUND
^/ p WC:
W 1709395 12/01/05
AC/%bk CffyOFLAQUINTA CSLB: 810111 07/31/06
PONCE DEQ
-------------'----------------------------------=-----------------------;------------------ ------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
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 Cl ss: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
0n issued.
+ te: Contractor: 5 x I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor.
7' 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
--------------
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, inthe performance of the work for which this permit is issued, I shall not employ any
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ti
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,
1� 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 b come subject to the workers' compensation provisions of Section .
1 - License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or _ ' 3700 of the Labor Code, 11 II foth those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Arth ri comply wi
ny 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).: Da Applicant:
1—) 1, 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' COMP SATION 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 applyto an owner of conditions and restrictions set forth on this application.
• property who builds or improves Ithereon, and who contracts for the projects with a contractorls) 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 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. d agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and c unty or finances and state laws relating to bmldin construction, a hereby authorize re resentatives
of thi y to mer upon the above-mentioned prope for ins ction p ses.
Lender's Name:
_ f9 te: Signature (Applicant or Agent
Lender's Address:
LQPERAITT
Application Number . . . . . 05-00002572
Permit BLDG POOL PERMIT
Additional desc .
Permit.Fee . . 162.00 Plan Check Fee
_ 105.30
Issue Date Valuation . .
. 15000
Expiration Date 12/21/05
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
w Issue Date Valuation
0
Expiration Date 12/21/05
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 12/21/05
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 12/21/05
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
LQPERMIT -
4�
�f of La Qbima
Bdicfir n. � Safery. Division
P.O. Box 1.504, 78-4'95. Cafle Tampico.
ermit #
Project Addra�:
A. P. Nurnoere&
La Quinra, CA 51 3 - (750) 777-7012
Building Permit Application and Tracking Sh8E.,
Adaress:.
LegalDesaiption:
Cin•. ST. Zip:
Con=cmr:' 10 CA
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Address.0•"O l
�u Pro'cct Dern tioti:
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State Lic. 4 : 8 Q` t
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Arcn.. E=— D=sl_a_ncr.
Address:
Cin. ST. Zip. .
Telephone:
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% Dc= Fa�z.�Cbnstruction Ty c.
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Proje_t npe (on 1 P_ a
Name!of-Cant=-Persor:
Sq. Ft.:
r Slorica: L'rim
Telcphone # of Contact Pelson:
— 4 tvDQ rstitnated Value orProjccw
APPLICANT: DO NOT WRITE BELOW THIS UTNE
R l
Submittal I
Req'd I
Rec'd
TPuCKING
PE'F?.ITT FEES
Flan Sets I
Plan Check submitted 106.Awi I
licm
:Amount
Structural Cal=
Reviewed. rcadh• for corrections
Plan Check Dcpos:--t
Truss C21cs, (
Called Contact Person .
Pian Check Bxiancc
Ttle _4 Calcs.
Plans picked up I
Construction
I
FTood plain plan
I
Plans resubmined ,
Mechanical
.Grading, plan I
.2 ' Rcvinv, rcadv for corrcctionsFissue
Electrical
Subcontactor List
I
Called Contact Person
Plumbing
`Giaat Deed
Plans picked up
IiO;A..Approvai
,
Pians resubmined
F.Gm.ding
`I'V HrJUSE _
I
3—Review. readyfor corrections/ issue
Dercloper Impan Fee
'Planning Apprm•al 'I:
I
Called Contact Person
A-LP.P. I
ITub.NVIL Appr
I
Date of permit issue