04-5088 (RPL)BUILDING & SAFETY DEPARTMENT
PI
�O. Box .1504 (760).777-7012
OFT "8-495 CALLE TAMPICO FAX (760) 777-7011
C� 6TYOFUaC3fl�i�6TP� . LA QUINTA,,CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
FINANCE DEPT
BUILDING PERMIT
Application Number
<,: X04=-000-050.88; Date,
6/22/04
Property Address
c . .`-8-05-6-O--VIA TALAVERA
APN:
772-250-999-128 -30357 -
Application description POOL .-..RESIDENTIAL
Property Zoning
LOW DENSITY RESIDENTIAL
.Application;.vaivation.. 15000
Owner
Contractor
M/M HOLTXMAN
PICASSO POOLS, INC
= ` 7`8078 COUNTRY. CLUB DR,
4206
80-`65:0. VIA TALAVERA
PALM.DESERT CA -92211:
SCOTTSDALE -AZI
85258- (760). 345-4600
t .
WCC: STATE FUND'. .
WC:. . 1709395
1,2/01/04
.""
CSLB:. 81011
11/20/04
CCC: . C2 7-053 -.B .
Permit . . ... . .
MECH POOL
Additional desc
Permit Fee
24.00 _- 'Plan Check Fee
6:00
Issue Date
Valuation
0
Qty ,Unit Charge
Per
Extension
BASE' FEE.'
-15.00
1.00 9.0.000
EA MECH FURNACE <=100K
9.00
Permit . . .BLDG
POOL PERMIT
-
Additional desc
°
Permit Fee.
162'.00• Plan Check' Fee
105.30
Issue Date. ..
Valuation
150.0
Qty Unit Charge
Per
Ektension
BASE .FEE
45.00
13.00 .9..0000
-,THOU BLDG 2,001-25,000
117.00-
Permit. . . . .
ELEC POOL PERMIT -RES
----------
.Additional-desc
Permit Fee
45.00.. Plan Check Fe.e
11.25
Issue Date.'.
Valuation
0
Qty,. Unit Charge,
Per.. _
Extension
BASE FEE -'
15.00..
P.O. Box 1504 • ����
78-495 CALLS TAMPICO VOICE (760) 777-7012FAX (760) 777-7011
L A QUINTA;'CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:. f F_
Date:
Applicant's Mailing Address:
Architect or Enginee :
Architect or E in r' Ss:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 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./D//
'License Class License No.
Dat r 'f7� Contractor ��F�QT!-C/�•
OWNER -BUILDER DECLARATION
'Cl hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): .
U 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 or 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.).
U I, as owner of theproperty, 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
� m ed. My w�A�ers' com ensation insurance carrier and policy number are.
Carver-- - e Policy Number= /7D ?343
I certify that, in the performance of the work for which this pe it 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 Code, I shall
forthwith comply with those provisions.
<Date--� fJ'41 Applicant- Ai" -
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.
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
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, indemnity 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 pernit, or
cessation of work for 180 days will subject permit to cancellation.
1 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 property for inspection purposes.
Date D� Signature (Applicant or Agent) —
Page 2
Application Number .
. . . '04-00005088
Date 6/22/04
Qty Unit Charge
Per
Extension
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
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
BE IN PLACE PRIOR TO
PREPLASTER
INSPECTION. EQUIPMENT
ENCLOSURE
NOT
INCLUDED IN PERMIT.
Fee summary Charged
Paid Credited
11
Due
Permit Fee Total
264.00
-
00 .00
264.00
-Plan Check Total
130.80
.00. .00
130.80
Grand Total
3:94.80
.00 .00
394.80
i
wr
A
f
PICASSO POOLS
L -IC 4t810111
POOL 5PEC5
SIZE: Y x 1'
AREA: 462 SF
PERIMETER: 102 F
DEPTH: 4 to -�
SPR SPECS
SIZE: 6xl
AREA: 38 SF
DAMWALL:
RAISED o: + "'
SPILL -TYPE- STACKED GOLF
OF JETS: 4
LIGHTS: I
FACE FINISH:
DIG/ EL
TYPE:
ACCESS:
ELEVATION:
DEEP RAMP:
BENCH/TAN-LEDGE:
CONC/SOD REMOVAL:
TREE REMOVAL:
IRRIGATION REPAIR:
RSB LENGHTS:
ROCK POCKETS:
PLUMBING
FILTER: 300 5F
POOL PUMP: 2 HP
ROOSTER PUMP:
HEATER:
TIME CLOCK: LENNoVATog
SUB PANEL:
RETURN INLETS:
SKIMMER:
AUTO -FILL:
GAS LINE:
STUB OUTS:
CASCADES:
sPRAYHEADS:
POOL LIGHTS:
SPA LIGHTS:
PLUMBING SIZE:
STUB sET EQ:
GUNITE
DEEP END RAMP:
2nd STEP:
LOVE SEAT
SPILLWAY TYPE:
CANTILEVER:
COPING:
RBB:SEE STEEL
TILE
TILE TYPE:
WATERLINE: SMS GR PH
TILE TRIM:
RBB TILE:
DECKING
COLOR: OMAHA TAN
5Q FT 1305 SF
FINISH:
EXTRA JOINTS:
CANTILEVER:
DECK DRAINS:
DECCO DRAIN:
CURB CORE:
STEPS:
STEPS FACE:
SUB BASE:
VISQUEEN:
BANDING:
STAMPED:
RELEASE :
MO�W��S� RR�I/P:
MASONRY
COPING TYPE:
RBB FACE:
SPILLWAY:
STEPS:
P/L EXT WALLS:
PLANTER WALLS:
RETNG WALLS:
EQ WALLS:
GATE TYPE:
R&R GATE:
BBQ
srzE:
/ BBQ MODEL:
TOP FINISH:
SIDE BURNER:
FACE FINISH:
PEN LIGHT
PLUG OUTLET
LIGHTS SWITCH:
PL R
PLASTER COLOR:
PEBBLE COLOR: TAgoE gLjjE
POOL LIGHTS: 2.400 WATT
SPA LIGHTS:
ROLLED BOND BEAM:
EYEBALLS:
OTHER
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LAN FOR
hN RESI
t
ADDRESS: 80-650 VIA 7ALAVERA
LA QUINTA
iT`t" OF LA UI _E 128 TRACT# A RE -INSPECTION FEE OF $30
UILDING & SAFETY R VI 1)IONS: WILL BE CHARGED IF THE AP PI ANS AND ing CAMME NOT ON
APP OV
FO ONSTRUCTI U 2) THE $ATF FOR AP/90HEDULED
3i
INSPECTION, DATE:
DATE sY
to Printed N O EX� N
i25 �P! Scale'
2:17 PM 6/18/04 Q] 1 1 zID
Drawing by: JUDY
1