04-7706 (RPL)Y J
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BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
C��►IOF 78-495 CALLE TAMPICO •` FAX (760) 177-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS.(760) 777-7153
BUILDING PERMIT
Application Number . . . 4�0D 0706 Date 12/09/04
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Property Address . . . . . 51389 VIA SORRENTO
APN: 772-250-997-89 -31349
Application description . . . POOL - RESIDENTIAL
Property Zoning . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . 15000
Owner Contractor
GREG HARTZLER PICASSO POOLS, INC
.51389 VIA SORRENTO 78078 COUNTRY CLUB DR, ##206
LA QUINTA, CA 92253 PALM DESERT CA 92211
(760") 345-4600
WCC: STATE FUND
WC: 1709395 12/01/05
CSLB: 810111 07/31/06
CCC: B -C27-053
Permit BLDG–POOLrPERMIT
` Additional des:,,:
I; Permit Feeth
162 00, Plan Check Fee 105.30
Issue Date„ C °4�� Valuation . . . 15000
DE 10 M4 Z
Qty. Unit arg.e;—Per;,;,,. Extension
i C;lARICE j)-;yfBASE FEE 45.00
13.00 -0'0'0'0 THTOU BLDG 2-,001 25,000 117.0 0
Permit . . . . . MECH POOL
Additional desc
Permit Fee 24.00 Plan Check Fee.— 6.00
Issue Date Valuation 0
Qty Unit Charge Per Extension
BASE FEE _ 15.00
1.00 9.0000 EA MECH'FURNACE <=100K' 9.00
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Permit . . . ELEC POOL PERMIT -RES
Additional-desc
Permit Fee 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
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Permit . . . . . PLUMBING
Additional desc
Permit Fee 33.00 Plan Check Fee 8.25
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: D �{ --7 -10 (p
Applicant:
Applicant's Mailing Address:
Date:
Architect or Engineer:
Architect or Engineer's Address:
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 Li se i�n�li force P,ffect. I O 1
icense Class
J License No.
Date I ontractor ' 4r" I C (],S� C)
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 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.
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
�i�s uec� My w�cers' cortpensation msur a carrier and policy nu�n ber a
arrier �i q } p TibU Rnl cry Number ( � � `12,R
_ 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 provisions.
/bate L Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLA FUL, 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 n
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 Quinta, its
officers, agents and employeesfor 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 upon the above-mentioned roperty for inspection purposes.
tognature (Applicant or Agent): a
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'Page 2 ,
Application Number' 04-00007706'
Date 12./09/04
Issue. Date Valuation `
0
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;- BBQ (#3020914),•
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. EQUIPMENT:
ENCLOSURE NOT INCLUDED ,
Fee,summary Charged Paid Credited
Due
Perm t�Pee Total 264.00 .00 .00
264.00
Plan`Check Total' 1.30.80, .00 .00
130.80.
Grand Total 394:80 .00 00
394.80
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