05-3526 (RPL)P.O. BOX 1504 ^'
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 05�.0000.3526� Owner:
Property Address: 51629—VIA`SORRENTO LOCKWOOD
APN: 772-250-997-79 -31349 - 6 51-629 VIA SORRENTO
Application description: POOL -'RESIDENTIAL D LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL r/
Application valuation: 15000 AUG 1 I 2005.
CITrof: LAQUINTA Contractor:
Applicant: Architect or Engine r: FICEDEPT-PICASSO POOLS, ' INC
WCC: STATE FUND
WC: 1709395
4
CSLB: 810111
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 my License is in.full force and effect.
Licensee ss: License No • --
�: Contractor: i
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).:
(_ 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 (Seca 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 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.).
1 I 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.). -
( 1 I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
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: '
LQPERMIT
VOICE (760) 777-7012
C FAX (760) 777-7011
INSPECTIONS (760) 777-7153
12/01/05
0.7/31/06
WORKER'S COMPENSATION DECLARATION
Date: 8/10/05
hereby affirm under penalty, of perjury one of the following declarations: '
_ I have and will maintain acertificate 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.
X
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
insurance carrier and policy number are:
Carrier B C27 C53 Policy Number - - - - - - - - - - - - - --
_ 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
�1 3700 of the Labor Cod I shall f rthwith comply with those provisions.
Date: r 0� Applicant: , tXY+...�
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.
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 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 appllcatlon 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 hat I have read this application and state that the above information is correct. I agree to comply with all
city county ordinances and state laws relating to buildin nstruction, and hereby authorize representatives
of, is cgunt to enter upon the above-mentioned grope or inspection purposes.
�+(� � Signature (Applicant or Agent):
Date: CE7
Application Number
05-00003526
Permit . .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . .
: 162.00 P1an'Check Fee
105.30
Issue Date . . . .
Valuation
15000
Expiration Date
2/06/06
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
26.0.0 Plan Check Fee
.6.50
Issue Date
Valuation . . .
. 0
Expiration Date
2/06/06
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
2/06/06
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,.
2/06/06
' 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
Special Notes and Comments
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
LQPERMIT
Application Number . . . . . 05-00003526
---------------------------------
Special Notes and Comments ,
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT.
INCLUDED -IN PERMIT.
Fee summary Charged Paid.
Credited
Due
-----
Permit Fee Total 266.00 .00
--------------------
.00,
.
266.00
. Plan Check Total 131.30 .00
.00
131.30
Grand'Total 397.30 .00
.00
397.30
.. LQPERMIT
FA-
.0 of b Quin'
-ty
Bd&zg. &r Safery. Division
P.O. Box 1.5C-,-', 7&40:D- C-afle Tampim
Li1c,,Ldnl:a,- CA 51=3 - (760) 7-77-7012
APPUCANT:
DO NOT WRIT—t; BELOW THIS LINE
—'djIIT
TRACIONG
FEES
Sez I
112n Check submitted
11cm
Stmcrx2j Zal= I
Reviewed. reads for corrections I
P!2n Check Def os:
T -rum C21 I
Called Contact Person.
Plan Check Rt nc-
Title'_ Cis
Plans picked up
:Flood,. I pia"
Pians resubmincd
Mechani=l
.Grad* pan
2' Revim. r=dv for corr-cmionslissuc I
Electrical
subcoUt2=Jr List
I
Called Contact Person
Flumbing, T
-,Grzw De --,-e
Plans picked up
rtsubmincd'
Grading
'Fq HOUSE--
"Revir.w, r=d-.- for corrmnomissue
Developer ITTMM Fez
Planningapproval
call ed Contact ?rrson
ftb.,whs� Appr
D-atcolpermit isuc
schoaf.F-=