05-0895 (RPL)BUILDING $SAFETY DEPARTMENT
Nil1,1s,54iNlTA (760).777-7012 .
OFTt1�9 78-490EC,t�--MPreO FAX (760)'777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . . 05--00`00089 Date 3/16/05
Property Address . . . . 51293 VIA SORRENTO
APN: 772-250-997.-.93 -31349
Application. description POOL —RESIDENTIAL,
Property_Zoning LOW.DENSITY RESIDENTIAL
Application valuation 15000
Owner Contractor
-------------------------
-------------
MEL RUDMAN. PICASSO POOLS, INC
74-943 SAGE DRIVE 78078 COUNTRY CLUB°DR, #206
INDIAN.WELLS CA .92210 PALM DESERT CA 922il
(760)° 345=4600
WCC: STATE FUND
WC: 1709395` 12/01/05
CSLB: 810111 07/31/06
CCC: B.C27 C53
Permit . . . . . . BLDG POOL PERMIT
Additional desc
Permit Fee 162.00 Plan Check Fee'. 105.30
Issue Date . . . Valuation 15000
Expiration Date 9/16/05
Qty Unit Charge Per Extension
BASE,FEE Lq 45.00
13.00 9.0000 THOU BLDG 2,001-25,000 117.00
77
Permit . . . . . . MECH POOL
Additional desc
Permit Fee 24.00 Plan Check Fee 6.00
Issue Date Valuation . . . . 0
Expiration Date 9/16/05
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 Valuati-on . . . . 0
Expiration Date 9/16/0.5
Qty Unit. Charge Per Extension
BASE FEE. 15.00
1.00 3.0.0000 EA ELEC PRIVATE SWIMMING 'POOL 30.00
j -
- - - - - - - - - - - - - - - ------ - ---------------------------------
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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: OSDate:
G� Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
&fereA G T-0 r -
Architect or Engineer's Address:
Lic. No.:
tSUILUINU PERMIT DECLARATIONS
"A
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
C de, and my License is in f e and effect. Si-
ense Class License No-/ b L D 11 1
4Ie U 31 ky65Contractot/?l cr,5sz rpOD LS
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. . BA P.C. for this reason
Date Owne
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. awodiers' compensation insurance careerprSd ol�cy nyrrPer ar .
arrier S J Policy Number r/ LV "lJC(
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
// forthwith comply with those pprroviJsions.
-date C A:,plicantr/ J �-
WARNING: FAILURE TO SECURE WORKERS' 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.
I hereby affirm under penalty of perjury that there is a construction lending I age cyorJthe peAGENCYING
performance of he work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
IMPORTANT Application is hereby made to the Director of Building and Safety APPLICANT Cor ap ACKNOWLEDGEMENT
rmit ubo he 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 Quinta, 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
constructionU
, andhereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
l�3l 1) Signature (Applicant or Agent):
Page 2
Application Number . . . . . 05-00000895
'Date. 3/16/05
Permit• . . . PLUMBING
Additional desc
Permit Fee .33.00 Plan Check Fee
8:.25
Issue.Date, Valuation
0
Expiration Date 9/16/05
,Qty Unit Charge Per
Extension
BASE FEE
15.00
2.`00 6.0000 EA PLB FIXTURE
12.00
1.00 3.0600 EA PLB.WATER INST/ALT/REP
-3.00
.1:00 3.0000 EA PLB GAS PIPE 174 OUTLETS
3.00
Special •Notes and Comments
POOL & SPA. BBQ #3020914.
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ALARMS/BARRIERS SHALL BE IN PLACE PRIOR
TO PRE -PLASTER INSPECTION. EQUIPMENT
ENCLOSURE NOT INCLUDED IN PERMIT.
•Fee summary Charged Paid Credited
Due..
. Permit Fee Total 264.00 ..00 - .00
264.00
Plan Check Total 130.80 .00 .00
130.80
Grand Total 394.80 .00 .00
394.80
+18" SPA
B JETS, STUCCO AND PAINT EX
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PLAN
PLAN FOR
ADDRESS: 51-293 VIA SORRENTO
LA QUINTA
LOT# 93
REVISIONS:
(1) DATE:
(2) DATE:
(3) DATE:
Date Printed 1/8 =1' Scale
02:06 PM 03/15/2005
Drawing by; JUDY
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