BPOL2016-018878-495 CALLE TAMPICO
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LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT. DEPARTMENT
BUILDING PERMIT
Application Number: BPOL2016-0188
Property Address: 78613 PEERLESS PL
APN: 770310020
Application Description: DADDINO RESIDENCE / WATER FEATURE & FIREPITS
Property Zoning:
Application Valuation: $22,000.00
Applicant:
DERYK AIREY CONSTRUCTION
77571 BURRUS CT
PALM DESERT, CA 92211
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed and
9 (commencing with Section 7000) of Division 3 of Busin ss
and my License is in full force and effect.
License Class: B, C29. C53 . License No.: 962: 8
Datie. `� SCJ' I Contra o
provisions of Chapter
nd Pyolessions Code,
OWNER -B ILDER Jame
TION
I, hereby affirm under penalty of perju that Ipt from the Contractor's State
License Law for the following reason (Sec. 03ness and Professions Code: Any,
city or county that requires a permit to cons , 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
he or she did not build or improve for the purpose of sale.).
( ) I, as owner of the property, am exclusively contractingwith 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.).
(_) 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
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
ANTHONY DA6DINO
78613 PEERLESS PL
LA QUINTA, CA 92253
Date: 12/28/2016
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Contractor:
DERYK AIREY CONSTRU
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77571 BURRUS CT
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PALM DESERT; CA 92211
(760)497-7654
Llc. No.: 962128
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 fo(by Section 3700 of the Labor Code, for the performance
of the wo for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Sein 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: MID-CENTURY INSURANCE COMPANY Policy Number: A09476102.
I certify tfiat in the performance of the work for which this permit is issued, I
shall not employ any person in any manne(so'as to become subject to the workers'
compensation laws of California, and agree that, F
ul eco a subject to the
workers' compensation provisions of Section 370 e011
de, I shall forthwith
comply with those provisions.
Date -
`f' F04-3 Q Applic t:�
"
WARNING: FAILURE TO SECURE WO KERS' COMPE SATION COVERAGE IS UNLAWFUL,
AND.SHALL SUBJECT AN EMPLOYER O CRIMINAL P NALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS 100,000). I ADDITION TO THE COST OF
COMPENSATION, DAMAGES -AS PROW D FOR I ECTION 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 arid'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 i ormation is correct.
.I agree to comply with all city and county ordinances and state la s rPating to building
construction, and hereby authorize representatives of thiscity to r'' poi the
above-mentioned property for inspection purposes. `!
Dat Zg 1 Signature (Applicant or Ag
Applicant: Contractor:
DERYK AIREY CONSTRUCTION DERYK AIREY CONSTRUCTION
77571 BURRUS CT 77571 BURRUS CT
PALM DESERT, CA 92211 PALM DESERT, CA 92211
(760)497-7654 .
Llc. No.: 962128
Detail: NEW COURTYARD WATER FEATURE AND TWO (2) FIRE POTS. [2 INCH GAS PIPING/#8 AWG IN 1 INCH CONDUIT ELECTRICAL) STACKED ROCK
PROPOSED HEIGHT IS 2'-6" AND SHALL BE SUPPORTED WITH ADDITIONAL REINFORCING PER POOL ENGINEERING SHEET. EQUIPMENT SHALL BE INSTALLED
IN ACCORDANCE WITH MANUFACTURER SPECIFICATIONS. 2013 CALIFORNIA BUILDING CODE
Date: 12/28/2016
Application Number:
BPOL2016-0188
Owner:
Property Address:
78613 PEERLESS PL
ANTHONY DADDINO
APN:
770310020
78613 PEERLESS PL
Application Description:
DADDINO RESIDENCE /WATER FEATURE & FIREPITS
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$22,000.00
Applicant: Contractor:
DERYK AIREY CONSTRUCTION DERYK AIREY CONSTRUCTION
77571 BURRUS CT 77571 BURRUS CT
PALM DESERT, CA 92211 PALM DESERT, CA 92211
(760)497-7654 .
Llc. No.: 962128
Detail: NEW COURTYARD WATER FEATURE AND TWO (2) FIRE POTS. [2 INCH GAS PIPING/#8 AWG IN 1 INCH CONDUIT ELECTRICAL) STACKED ROCK
PROPOSED HEIGHT IS 2'-6" AND SHALL BE SUPPORTED WITH ADDITIONAL REINFORCING PER POOL ENGINEERING SHEET. EQUIPMENT SHALL BE INSTALLED
IN ACCORDANCE WITH MANUFACTURER SPECIFICATIONS. 2013 CALIFORNIA BUILDING CODE
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DESCRIPTION " ' ""` rACCOUNT T
QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306
0 .$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT- f
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
.0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC .
101-0000-42600 y
0
$25.33
Total Paid for PLUMBING FEES: $38.00
DESCRIPTION
ACCOUNT
• QTY
AMOUNT
WATER FEATURE
' . 101-0000-42404
0
$190.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER FEATURE PC
M1' 101-0000-42600
0
$103.36
Total Paid for POOL / SPA: $293.36
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TOTALS
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: p^� ,; B(rffdtn$ at Safety Division
V P.O Box 1504,78-495 Calle Tampico
La.QWnta, CA 92253 -:(760) 777-7012
'Building Permit -Application' and Tracking Sheet
Pe it 6 �A
1 lot`s
Project.Addnss:g(� �S
Owner's Name:.
A- P. Number.
Address: % Cp(3TEQEV�m 'Piz
Legal Description:
City, ST, Zip: }t, ,� QA,
Contractor. A VeN CvJ
Telephone% 15, ? 351
Address:15VEM C
Project Description:
City, ST, Zip: l.M l:�. 2 ('
�� ' eyI t W _
Telephone: J :- '
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State Lio. # : 1 `3 - City Lic #•:
Arch, EW., Designer.
Addles:
City, ST, Zip:
Telephone: ->
State Lie. #:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Confect Person: � G,
Sq. Ft.:x
#Stories: #Unita:
Telephone # of Contact Person: ��:
Estimated Value of Project.\
APPLICANT: DO NOT WHITE BELOW THIS LINE
#
Submittal ;
' Req'd
'Reed
TRACKING
PERMIT FEES•
Plan Sets
Plan Cheek submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Titus Calcs.
Called Contact Person
Platt Check Balance.
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.' .
Mechafdk d
Giading plan
V, Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
ML
H.OA Approval
Plans resubmitted
Grading
IN ROUSE:-
2" Review, ready for correcdonsALssue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
HU;UVEL)
.-DEC 19 2016
-CITY OF LA OUINTA
COMMUNITY DEVELOPMENT
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C-FF"YOF LA QUINTA
BLAILDING & SAFETY DEPT.
APPROVED
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