06-4145 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning: .
Application valuation:
166-00004145
77420 VISTA ROSA
658-220-022- - -
POOL RESIDENTIAL -
LOW DENSITY RESIDENTIAL
50000
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MULLIN JOHN F
C/O GREEN ACRES TRUST
2'033 MONTEREY RD
SOUTH PASADENA, CA 91030
VOICE (760) 777-7012
.FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: - 11/30/06
Contractor.
Applicant: Architect or Engineer: GATTUSO POOL CORPORATION r 1l
667 S. EUGENE ROAD ��`• G
PALM SPRINGS, CA 92264 l�►Q�,��
a I (760)3.27-7592 ' C,r(O�cedEp`�•
Lic. No.: 672850
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and, effect.- _ I have and will maintain.a certificate of consent to self -insure for workers' compensation, as provided
License Class: C53- License No.: 672850 - for by Section 3700 of the Labor Code, for the, performance of the work for which this permit is -
issued.
Date: I B ntractor. 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are: -
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 16150742006
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit.to_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, - -
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State - and agree that, if I should become subject to the workers' compensation
9 provisions of Section
License Law (Chapter (commencing with Section 70001'of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with those provi ens
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).: ate:. ji r G6 , icant:
(_ 1 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN -EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
_ - and who does the work himself or herself through his or her own employees, provided that the DOLLARS 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, -the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT -
1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of - conditions and restrictions set forth on this application.
- property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed - 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License'Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, -
(_ I I am exempt under Sec. , B.&P.C. for this reason 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.
Date: Owner: 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
CONSTRUCTION LENDING AGENCY _ permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for. the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinances and state laws relating to building construction, and hereby authorize re r ntatives
of this unty to enter upon a above-mentioned property for inspection purposes._. ,
Lender's Name:
ate: 8 ignature (Applicant or Agent):
Lender's Address:
LQPERAI IT
Application Number .
. . 06-00004145
Permit . . . .:. .
BLDG POOL PERMIT
Additional desc .
Permit Fee . . . .
414.50 Plan Check Fee
269.4.3
Issue Date
Valuation.
50000
Expiration Date
5/29/07
Qty Unit Charge
Per
Extension
BASE FEE
252.00
25.00 6.5000
--------------------------
THOU BLDG 25,001-5.0.,000
------------------------------------
162.50
--------------
Permit
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date
Valuation
0
Expiration Date
5/29/07
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 ._
5/29/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
.EA ELEC PRIVATE SWIMMING POOL
30.00 =
Permit
PLUMBING
Additionaldesc.
Permit Fee . .
33.00 Plan Check Fee
8.25
Issue Date . . . .
Valuation
0
Expiration Date
5/29/07
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, WATER FEATURE.
LQPERMIT
Application Number . . . . . 06-00004145
Special Notes and Comments
-----------------------------
----
ALARMS/BARRIERS SHALL BE IN PLACE
AT
'
- PRE -PLASTER INSPECTION. EQUIPMENT
ENCLOSURE NOT INCLUDED
Fee summary Charged
Paid
Credited
Due
Permit Fee Total 518.50
.00
.00
518.50
Plan Check Total 295.43
.00
.00_,
295.43
Grand Total 813.93
.00
.00
813.93
LQPERMIT - -
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City
ty •f La Quint
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Building a Safety Division
' P.O. Box 1504
Permit #78-495
Calle Tampico
La.Quinta; CA 92253
..Building Permit Application,and Tracking Sheet„
1 s
Project Address: 7 7 --4 2 VTC —
Owncr s Name: GA
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A. P. Number: •
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Description:
Ci nST. Zip: Y
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Contractor. G�-RV.SDQOot_CD9
Telephone: 3NE6 -711
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Address: (0(,07 G Ujb'F N F
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Project Description:
Cin' -ST. Zip: i2 I IJ tr _• Gly ZZ LD
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Telephone: Z 5 Z
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City Lic. #:StateLic.=• p p
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Arch.. Eng.. Designer- iYL •
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Address: 7.3(061
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City. ST. Zip: ,t(,M - Qk;56 7_ CA T Z Zpc
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Telephone: 7 _ 5
Construction Type: Occupancy;
State Lic.
Project type (circle one): New Add'n Alter Repair
Demo
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Name of Contact Person: C ai2�
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Sq. Ft.: °
#Stories:
F# Units:
4
Telephone = of Contact Person: 37-7- 73 Z.
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