05-3552 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4.4 a
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
i�05=-00003552 1''
Owner:
Property Address:
~51629-VIA—SORRENTO
LOCKWOOD
APN:
772-250-997779 -31349 -
51-629 VIA SORRENTO
Application description:
STRUCTURES OTHER THAN BUILD-
LA QUINTA, CA 92253
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2200
UJ
AUG ZDUJ
Contractor:
'Applicant:
Architect or Engineer
CIYBpdul"'PA
PICASSO POOLS, -INC
FINANCE DEQ•
WCC: STATE FUND
WC:- 1709395
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.
License ass: License No.:
✓Date: Contractor: 1
OWNER -BUILDER DECLARATION
1 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'tlie 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).: .
(_ ) I, as owner of the property; or my employeeswith 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 through his or her own employees, provided that the
improvements are not intended orofferedfor 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 1 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.). .
(_) 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
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/11/05
12/01/05
07/31/06
WORKER'S 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
x - 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. 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
3700 of the Labor 50 %1 shall fo with comply with those provisions.
D. Applicant'
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.
t. 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, eachagreesto, 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 workbeing
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 co to enter upon the above-mentioned property for inspe ion p oses.
J
Date: l7 Signature (Applicant or Agent):
J
Application Number
05-00003552
Permit . . .
BUILDING PERMIT
Additional desc -
Permit Fee
54.00
Plan Check,Fee
35.10
Issue Date
Valuation
2200
Expiration Date
2/07/06 -
Qty 'Unit Charge
Per
Extension
BASE
FEE
45.00
1.00., 9..0000
----------------------------------------------------------------------------
THOU BLDG
2,007-..25,000
9.00
Permit
ELEC-MISCELLANEOUS
Additional desc .
Permit•,Fee
1.5.90
Plan Check Fee
3:98
Date ate
Valuation
_ 0 _
Expiration Date';
2/07/06
-
Qty Unit Charge
Per
Extension
•
BASE
FEE.
15.00
^ 2.00. .4500
EA 'ELEC
DEVICE./FIXTURE'>20 .-
90
Permit
PLUMBING
Additional desc
Permit Fee
-18.00
'Plan ,Check Fee ._
4:50
Issue Date
Valuation
0
Expiration Date
2/07/06
Qty -Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 3.0000
EAPLB GAS PIPE 1-4.OUTLETS
3.00 .
------------"---_----------------------------------
Special Notes and Comments
--------------------
BBQ #3020914
Other Fees .
. . . ENERGY REVIEW FEE,
3'.51
Fee summary Charged
Paid Credited
Due
Permit-Fee Total
87.90
----------
.00 00
87.90
PlanCheck ,Total
43.58
.00. ..00
43.58
Other Fee Total
3.51.
.00 .00
3.51
Grand Total
134.99
.00 .00
134.99
" LQPERMIT
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BLUI&Q g. &r Safely Division
P.O..Boz 1.504, 78-4, 5) - Cafle iarnpicD .
!a QWri a, CA '51 3 - (760) T/7-7012
Building Permit Application and Trackin Shoe:.
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Cir. ST. Ztn: r q
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Cin' Lic r.
Construction Type:
Project t1•pc (circle one): lvwr Add'n ;'Aj=r R=ain- D
Sq. FL: r Stories: L'ri=
545- e } t00® tstintated Value of Prof oC[ 02 dJt�
APPLICANT: DO NOT WRr7-E BELOW THIS LINE ;. .
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Sabmitsal I
Req'd I
P -.--'d
T LaCKING
n• FEF -
?fan cep I
I
Pan Check submittedI
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ltetn
:�rt[:5urs[
strstetz al aim I
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R-wiex ed reads for corrections I
Plan Check Dcpos�
Tr= C21c--
Called Contact Person.
Plan Check 41.2nc:
.Title _9
Plans picked up I
Construction
I ZeO
r[bod plais Play
,
Plans resabmitt_d I
Mechanical
Brading p--=nI
I
„ Ret-im. rcadr for eorreetionsitsue I
Elettrictl F 42
Subcoatmc6r List
I
Called Contact Prrson (
Plumbing I Ot�TL.G'C
Giaw DcS
Plans picked up
HLO—L.AFproval
I
i'larss resubmincd
Grading
N Hc4us—=_
I
,..Review. reed_ for correctioasitssue
Dc doper 1[epan rr.
Plana* Approt•al `I:
I
Called Contact Person
I•PitICNks. Appr
I
Datc of permit issue
Tatai Pumi<iiFeu I`