13-0755 (RPL)4P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO '� FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT 01 INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/21/13
Application Number: 13-0000075S Owner:
Property Address: 79883 CASSIA ST BRAYSHER MIKE
APN: 649-480-004-16 -28601 - 79883 CASSIA ST D
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253.
Property Zoning: MEDIUM DENSITY RES (
Application valuation: 10000 JUN
1,! 21103
Contractor:
Applicant: Architect or Engineer: GORDO LANDSCAPE, JAVI R CITY OF LAQUINZA
P.O. BOX 7123 FINANCE DEPT
LA QUINTA, CA 92248
N(760)619-4906
Lic. No.: 883625
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm underpenalty 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 lass: • C27 D06 //�� License No.: 8883625
Date: �-' O 3 Contractor: Zs tc %Cr ([Ofab L_r, tidsckee_
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 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 he or she did not build or
improve for the purpose of sale.).
(_ 1 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.).
1 _ 1 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
----------------------------------------------—
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:
CarrierXEMPT Policy Wumber EXEMPT
I certify that, in the performance of [h rk for which this permit is issued, 1 shall not employ any
person in any manner so as t bemubject to the workers' compensation laws of California,
and agree that, if I sho e m Lsu sect to the workers' compensation provisions of Section
3700 of the Labor e. I orthwith comolv with those orovisions.
Date. 'L zl Applicant: _
WARN NG: FAILURE TO SECURE
SUBJECT AN EMPLOYER TO CRII
DOLLARS 1$100,000). IN ADDly
SECTION 3706 OF THE LABOR C
RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
\L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
. 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 ove' rmation is correct. I agree to comply with all
city and county ordinances and state laws relating to but ding c s uction, and hereby authorize representatives
of this co ty to/enter upon the above-mentioned pro rty for " ection purposes.
Oat : V Z I Signature (Applicant or Agent):
t /
Application Number . . . . . 13-00000755
Permit . . . . . . POOL 2013
Additional desc . .
Permit Fee 178.75 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 12/18/13
Qty Unit Charge Per
Extension
1.00 178.7500 EA MISC POOL/SPA
----------------------------------------------------------------------------
178.75
Permit . . . . . WALL/FENCE PERMIT 2013
Additional desc . .
Permit Fee . . . . 47.19 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 10000
Expiration Date 12/18/13
Qty Unit Charge Per
Extension
1.00 - 47.19-00 LS MISC WALL, FIRST 100 LF
47.19
----------------------------------------------------------------------------
Special Notes and Comments
POOL AND 15LF OF 6' HIGH EQUIPMENT WALL
EQUIPMENT SHALL BE INSTALLED IN
ACCORDANCE WITH MANUFACTURER.
SPECIFICATIONS. ALARMS AND BARRIERS
REQUIRED TO BE INSTALLED AT PRE -PLASTER
INSPECTION_. 2010 CALIFORNIA BUILDING
CODE.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, POOL
97.24
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 225.94 .00 .00
225.94
Plan Check Total .00 .00 .00
.00
Other Fee Total 98.24 .00 .00
98.24
Grand Total 324.18. .00 .00
324.18
LQPERAI IT
Bin #
Qty t/ of LQ Quin to
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
,..l�Lj
'
Project Address: —883 ('C,-sxjj 54
Owner's Name: MiKe, R Y l
A. P. Number: LO Qu-AM, Cit- ri -Z
Address: c ,E> 64S )-q sf
Legal Description: ] deh(-(- f {JKiJ
City, ST, Zip: Qt4i,114 c 22j� 3
Contractor: ZGVc-,/ 6346 ,LeV\jSCePe,9
Address: �Ij �4��'Ser� S (�� pY
Telephone: -
Project Description:
City, ST, Zip:U �U i�� Z��
��u tyVt ✓1 —.G�k !r/+��
Telephone: GG
State Lic. # : ff)3j(o2
City Lic. #.: 0A) Films
/S � I-earttr r{ Yr 4
Arch., Engr., Designer: v'j�OC �i� �w
Of pw K/6GC-
Address: (Zp I jlf 14 si i h l
�/LCQ g7,WA11tR QS
City, ST, Zip: Niek 6"K (14 q?-66-
Telephone: *71 L/-40 ;(o// �
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Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #: �q rj Z.�
�.v 1.a r
Name of Contict Person: '/10(1
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: X)0-
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/'issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit'
LA Q U' NTA
School Fees
BU
LDING & SAFETY DEPT.
Total Permit Fees
FOR GONb I KUU I iUly
DAT Ek BY
-FOOL
Q tccK (�l� hU �l
0 OSE
-QEF'
CITY OF LA QUINTA
BUILDING & SAFETY DEPT,
APPROVED
�-
-FOR CONSTRUCTION
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Check a License - License Detail - Contractors State License Board
Page 1 of 2
DEPARTMENT OF CONSUMER AFFAIRS
Contractors State License Board
Contractor's License Detail - License # 883625
Al- DISCLAIMER: A license status check provides information taken from the CSLB license database. Before
relying on this information, you should be aware of the following limitations.
CSLB complaint disclosure is restricted by law (B&P 7124.6) If this entity is subject to public complaint disclosure, a link
for complaint disclosure will appear below. Click on the link or button to obtain complaint and/or legal action information.
>> Per B&P 7071.17 , only construction related civil judgments.reported to the CSLB are disclosed.
:> Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration.
Due to workload, there may be relevant information that has not yet been entered onto the Board's license database.
License Number 883625
JAVIER GORDO LANDSCAPE
Business Information Business Phone Number: (760) 619-4906
P0BOX 7123
LA QUINTA, CA 92248
Enti Sole Ownership
Issue Date 09/05/2006
Expire Date 09/30/2014
Extract Date 6/18/2013
This license is exempt from having workers compensation insurance; they certified that
they have no employees at this time. -
Effective Date: 07/21/2010
https://www2.cslb.ca.gov/onlineservices/checklicenseII/LicenseDetail.aspx?LicNum=8836... 6/18/2013
ACTIVE
License Status
This license is current and active. All information below should be reviewed.
CLASS DESCRIPTION
C27 LANDSCAPING
Classifications
B GENERAL BUILDING CONTRACTOR
D06 CONCRETE RELATED SERVICES
CONTRACTOR'S BOND
This license filed a Contractor's Bond with
WASHINGTON INTERNATIONAL INSURANCE COMPANY.
Bonding
Bond Number: S9156786
Bond Amount: $12,500
Effective Date: 02/01/2013
Contractor's Bond History
Workers' Compensation
WORKERS' COMPENSATION
This license is exempt from having workers compensation insurance; they certified that
they have no employees at this time. -
Effective Date: 07/21/2010
https://www2.cslb.ca.gov/onlineservices/checklicenseII/LicenseDetail.aspx?LicNum=8836... 6/18/2013
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