05-3649 (BLCK),y c.
Ab
P.O. BOX 1504
78-495 CALLE TAMPICO.
LA QUINTA, CALIFORNIA 92253
Application Number: OS -00003649
Property Address: 51485 VI'A SORRENTO
APN: 772-250-997-85 -31349 -
Application description: WALL/FENCE
Property Zoning: LOW-DENSITY RESIDENTIAL
Application valuation: 160
•
M
AUG BYE °JNIO'r'
• . I. L CITY OF -LAQUINTA
,PARTMENT
MIT
Owner:
STEVE WALTERS
51485 VIA SORRENTO
LA QUINTA, CA 92253
VOICE (760) 777-7012 /
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/17/05
LQPERMIT -
Contractor: ,
Applicant: Architect or Engineer:
PICASSO POOLS, INC '
78078 COUNTRY. CLUB DR, #206
PALM DESERT, CA 92211
(760)345-4600
LiC. No.: 810111
- LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under:penalty ofperjury 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 DMsion3 of the Business and Professionals Code, and my License is in fullforceand effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: 'B C2711253 L'ense No.: 810111
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is.
'ti( L.L`�•5 ractor. �r
-r
issued.
_ have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for for is issued. My
the performance of the work which this permit workers' compensation
-'�' -•k"d OWNER -BUILDER DECLARATION. -'
insurance carrier and policy number are:
F��-.I;hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
-
Carrier STATE FUND_ Policy Number 1709395 -
��_tifollowing;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;talter, improve,,de-coolish, 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 shall 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 hundre d dollars ($500).:
scant:-
(_ L 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
(_) 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 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,
(_ 1 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 Ihave 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 pur oses.
'Lender's Name: - -
(Applicant or Agent): a
-ature
Lender's Address:
-
LQPERMIT -
Aug.17— 2005 3:08PM PICASSO POOLS No,0638 P. 3
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PICASSO POOLS
78-078 COUNTRY CLUB DR. #206
BERMUDA DUNES, CA. 92203