06-2404 (BLCK)_,:P.O. BOX 1504
778-495 CALLE TAMPICO '
LA QUINTA; CALIFORNIA 92253
Application Number:
Property Address: -
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00002404
51725 VIA SORRENTO
772-250-997-75 '-31349 -
WALL/FENCE
LOW DENSITY RESIDENTIAL.
108
Architect or Engineer:
I�
�". VOICE "(760) 777-7012
- - . FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/15/06
Owner.
JAN CLARK
51-725' VIA SORRENTO
LA QUINTA, CA 92253
(760)346-0993
LICENSED CONTRACTOR'S DECLARATION
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 P fessionals Code, and my Licenseisin full force and effect.
License Class: B C27 C53 se o.: 810111
oate Contractor..
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,
5500).:1, 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 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.). "
f _.) 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—) I am exempt under Sec. - BAP.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
Contractor:
PICASSO POOLS, INC
78078 COUNTRY CLUB DR, #206
BERMUDA DUNES, CA 92201--0
(760)345-4600
LiC. No..: 810111
U
.JUN 20:2005
CITY OF LA QUINA
FINANCE DEPT.
_ 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
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 STATE FUND Policy Number 1709395
I.cenify 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' compensationlaws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Cod rthwith c ply with those provisions.
Date,/,,, Applicant:
i
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'upori.'.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 1 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
sc/county
sssto enter upon the above-mentioned propertw'Wection purpo s. -
Dai�,p Signature -(Applicant or Agent)'
Application Number 06-00002404
- Permit . . . WALL/FENCE PERMIT
'
Additional desc .
Permit Fee 15.00
Plan Check
Fee
.00
Issue Date-
Valuation
108
Expiration Date .. 12/12/06
Qty Unit Charge Per,`
Extension,
BASE FEE.
15.00
-------------------------------------------_----------
Special Notes.and Comments
5LFX5' EQUIPMENT WALL CITY STANDARD
Fee summary Charged Paid
Credited"
Due
-------- ----------
Permit Fee Total 15.00
----------
.00
----------
.00
15.0.0
Plan Check Total, .00
.00
.00
.00
Grand Total 15.00
.00
.00
15.00
' LQPERMIT• ..
_
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Jun.15, 20H 4:18PM PICAS
CITY STANDARD WALK
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