05-4988 (SOTB)e
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&ty/ 4 4 Q"
Application Number: 05-00004988
Property Address: 80575 VIA TERRACINA
APN: 772-250-999-85 -30357 -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1200
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Class: License No.:
Contracto :��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 ($5001.:
(_ 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 (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or imprnves thereon,
and who docs 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, 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 contractors) 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:
LQPERMTf
Owner:
WEAVER
80-575 VIA TERRACINA
LA QUINTA, CA 92253
Contractor:
PICASSO POOLS, INC
WCC: STATE FUND
WC: 1709395
CSLB: 810111
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/10/05
D°
NOV 15 2005
CITY OF LA QUINTA
FINANCE DEPT
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
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 Labbcor/Code, I shall forthwith comply with those provisions.
tel Applicanf
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 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 propeW46r inspection purposes.
atet 111'r9J Signature (Applicant or Agent)
Application Number . . . . . 05-00004988
Permit BUILDING PERMIT
Additional desc .
Permit Fee . . . . 29.00 Plan Check Fee 18.85
Issue Date . . . . Valuation . . . . 1200
Expiration Date . . 5/09/06
Qty Unit Charge Per Extension
BASE FEE 15.00
7.00 2.0000 HIND BLDG 501-2,000 14.00
----------------------------------------------------------------------------
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 18.00
Issue Date
Expiration Date . . 5/09/06
Plan Check Fee
Valuation . .
4.50
0
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 3.0000 EA PLB
GAS PIPE 1-4
OUTLETS
3.00
--------------------------------
Special Notes and
-------------------------------------------
Comments
FIREPIT ONLY.
----------------------------------------------------------------------------
Other Fees . .
. . . . . .
ENERGY REVIEW
FEE
1.89
Fee summary
Charged
----------
Paid
---------- ----------
Credited
----------
Due
-------------- - --
Permit Fee Total
47.00
.00
.00
47.00
Plan Check Total
23.35
.00
.00
23.35
Other Fee Total
1.89
.00
.00
1.89
Grand Total
72.24
:00
.00
72.24
LQPERMIT
GAS METER
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE 1112�BY `S!7
PICASSO POOLS
LIC #810111
POOL SPECS
: 16'X 33'
AREA: 472 SF
PERIMETER: 102 LF
DEPTH: -3' TO -5'
SPA SPECS
SIZE:
AREA:
RAISED @:
SPILL TYPE:
# OF JETS.
LIGHTS.
FACE FINISH:
ACCESS:
ELEVATION:
DEEP RAMP.
BENCH/TAN-LEDGE:
CONC/SOD REMOVAL.
TREE REMOVAL:
IRRIGATION REPAIR:
RBB LENGHTS:
ROCK POCKETS:
PLUMBING
FILTER:
POOL PUMP:
BOOSTER PUMP-
HEATER:
UMP:HEATER:
TIME CLOCK:
POOL CONTROL
RETURN INLETS:
SKIMMER:
AUTO -FILL:
GAS LINE
STUB OUTS:
CASCADES:
SPRAYHEADS:
POOL LIGHTS:
SPA LIGHTS:
PLUMBING SIZE:
STUB SET EQ.
GUNITE
POOL B -EE
2nd STEP:
LOVE SEAT:
SPILLWAY TYPE:
CANTILEVER:
COPING:
T DIAMETER
38 SF
+30'1
STACKED SILVER QUARTZITE
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GATE TYPE:
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BBQ MODEL:
TOP FINISH:
SIDE BURNER:
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PEN LIGHT:
PLUG OUTLET:
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ADDRESS: 80-575 VIA TERRACINA
LA QUINTA
LOT# 85
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STEPS:
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RETNG WALLS:
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GATE TYPE:
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BBQ MODEL:
TOP FINISH:
SIDE BURNER:
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PEN LIGHT:
PLUG OUTLET:
LIGHTS SWITCH:
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ADDRESS: 80-575 VIA TERRACINA
LA QUINTA
LOT# 85
REVISIONS:
(1)
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(2) DATE:
(3) DATE:
Date Printed 1/811= 1 ' Scale
11:38 AM 11/8/05
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