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BPOL2016-002378-495 CALLE TAMPICIC-rCO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: LINDA EVANS 54200 EISENHOWER DR LA QUINTA, CA 92253 c&ht 4 4 Qumrcu COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BPOL2016-0023 54200 EISENHOWER DR 774221027 EVANS RESIDENCE / POOL REPAIRS $970.00 I IIIIII I32 III' IIII IIII JAR 0 3 2015 L/ CffYcl-L.Cilbi''F. COMMIfNm DE'!ELd. ,� +:ri DEP`+°T�`t�� LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class: C10 License No.: 905152 Date: 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).: (_) 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 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 Vcnstdid not build or improve for the purpose of sale.). rs owner of the property, am exclusively contracting with licensed contractors ct 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 CONSTRUCTION LENDING A—II/�--C/` I hereby affirm under penalty of perjury that there is a construction lending agency the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Lender's Add VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date:. 3/3/2016 Owner: LINDA EVANS 54200 EISENHOWER DR LA QUINTA, CA 92253 Contractor: PROGRESSO ELECTRIC 79140 KAYE CT LA QUINTA, CA 92253 (760)343-8952 Llc. No.: 905152 WORKER'S 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 issued. My workers' compensation insurance carrier and policy number are: Carrier: 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 Code, I shall forthwith comply with those provisions. Date: 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 Building Official 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 is city 4enter u the �eg nned property for inspection purpos Signature (Applican r Agent - DESCRIPTION FINANCIAL INFORMATIO ACCOUNT- QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE' 101-0000-20306 0 $1.00 $0.00 "PAID BY :"METHOD :' , RECEIPT # CHECK # CLTD BY " Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SWIMMING POOL/SPA. 101-0000-42404 0 $181.29 $0.00 PAID BY METHOD RECEIPT,# CHECK # CLTD BY Total Paid for POOL / SPA: TOTALS:00 $181.29 $0.00 Description: EVANS RESIDENCE / POOL REPAIRS Type: POOL Subtype: Status: APPROVED Applied: 3/3/2016 MFA Approved: 3/3/2016 MFA Parcel No: 774221027 Site Address: 54200 EISENHOWER DR LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 297 Lot: 16 Issued: UNIT 27 STAFF NAME Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $970.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 NOTES Details: POOL REPAIRS: INSTALL SELF CLOSING/LATCHING GATE, GATE LATCHES AT 60", DECREASE GAP LOWER GATE/GRADE, ENSURE WALL HEIGHT IS 60", INSTALL GFCI BREAKERS ON POOL EQUIPMENT AND INSTALL RECEPTACLE COVER ON POOL PANEL PER 2013 CALIFORNIA BUILDING CODE. AnnITIMUAI CITFG FINANCIAL INFORMATION Printed: Thursday, March 03, 2016 3:09:34 PM 1 of 2 O SYSTEMS CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES NOTE MARY FASANO 3/3/2016 3/3/2016 ANGELICA GAVE ME APPLICATION FOR MAYOR EVANS. CONDITIONS NAME TYPE NAME ADDRESSI CONTACTS CITY STATE ZIP .PHONE FAX EMAIL APPLICANT LINDA EVANS 54200 EISENHOWER DR LA QUINTA CA 92253 CONTRACTOR PROGRESSO ELECTRIC 79140 KAYE CT LA QUINTA CA 92253 OWNER LINDA EVANS 54200 EISENHOWER DR LA QUINTA CA 92253 FINANCIAL INFORMATION Printed: Thursday, March 03, 2016 3:09:34 PM 1 of 2 O SYSTEMS Printed: Thursday, March 03, 2016 3:09:34 PM 2 of 2 SY57FM5 CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY • BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: SWIMMING POOL/SPA 101-0000-42404 0 $181.29 $0.00 Total Paid for POOL / SPA: $181.29 $0.00 TOTALS:00 Printed: Thursday, March 03, 2016 3:09:34 PM 2 of 2 SY57FM5 t.