BPOL2017-001578-495 CAI -LE TAMPICO VOICE (760).777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGN :&.DEVELOPMENT -DEPARTMENT INSPECTIONS (760) 777-7153
BUILDINGPERMIT'
Date: 2/22/2017
Application Number: 8POL2017-0015
Owner:
Property Address: 78613 PEERLESS PL'
ANTHONY DADDINO
APN: 770310020:78613
PEERLESS PL w
Application Description: DADDINO RESIDENCE / PPOL & SPA REMODEL
LA,QUINTA, CA 922 s
Property Zoning:r�
a w
Application Valuation: $30,000.00.
C=:) N SWC
aUJ
o_
0
Applicant:
Contractor. o Lu
DERYK AIREY
.DERYK'AIREY m 0 o
77571 BURRUS CT —
77571'BURRU$ CT_LJ
PALM DESERT, CA 92211
:PAL'M'DESERT; CA 922 1
0
(760)497-7654'
Lic. No.: 962128
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION. DECLARATION
I hereby affirm under penalty of perjury that I am licehs6&under provisions of Chapter.
I hereby affirm under Penaltyof perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3'of th u_ ' ess and P ofessions Code,
I have and will maintain certificate of consent to self -insure for workers'
and my License is in full force and effect.
compensation, as,(provided for by Section 3700 of the Labor Code, for the.performance
License Class: B. C29, C53 License No.: 1
of the,work for which this per`mrt,is issued. 4
1'�
[have and will maintain workers':compensation insurance, as required by
` ' Contractor.Sectio00.of
Date:? ° �Z t
the Labor Code, for the performance of the work for which this permit
is issued. My.workers' compensation. insurance carrier and policy number are:
OWNER-BUI ER DECLARA ON
Carrier: MID-CENTURY INSURANCE COMPANY Policy Number: A09476102
I hereby affirm under penalty of perjury th t i am ezem t from the Contractor's State
License Law for the following reason (Sec. 7, 5, Busin ss:and Professions Code: Any ,
I certify that in;the: performance of the work for which this permit is issued, I
city or county that requires a permit to constru Iter--: mprove,-demolish, or repair
shall not employ any person in any manner so as to'become subject to the workers'
any structure, prior to its issuance, also.requires the applicant for the permit to file.a .
compensation laws of California; and agree tha, i ould ecome su ject to the
signed statement that he or she is licensed pursuantto the provisions of the
workers' compensation provisions ofbection'37 0'of; h a or Co shall forthwith
Contractor's State License Law (Chapter 9 (commencing.with Section 7000) of Division
'comply with those provisions.
3 of the Business and Professions Code),or• that he orshe is exempt therefrom and the
ZZ `
basis for the alleged exemption. Any violation ofSection 703i.5'6y,anyapplicant fora
Date: 1.Qlicant:.,permit
subjects the applicant to a civil penalty of not morethan five hundred dollars($500).:
WARNING: FAILURETO SECCOMP SATION COVERAGE IS UNLAWFUL,
I, as owner of the property, or my employees with.wagesastheir-sole
AND SHALL SUBJECT AN ElulMINAL ENALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure isnot intended or offered forsale.. `
ONE HUNDRED THOUSAND;,000). IN'ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Codec The Contractors' State LicenseLaw does.not
COMPENSATION; DAMAGES FOR I SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who buildsor•improves thereon, and who does the work
INTEREST, AND ATTORNEY'S
himself or herself through his or her own employees, provide&that the improvements
are not intended or offered for sale. If,however,thelbuild-ing or improvement is soldAPPLICANT
ACKNOWLEDGEMENT
within one year of completion, the owner-builder.wiil have the.burden of proving that!.
IMPORTANT: Application is hereby made to'the Building Official for a permit subject to
he or she did not build or improve for the purposed sale).'
the conditions and restrictions set forth on this application.
(� I, as owner of the property, am exclusively'contracting with. licensed contractors.
1. Each person, upon'wliose behalf this application is made, each person at whose
to construct the project. (Sec. 7044, Business•and;Professions Code: The Contractors'
request and forwhose benefit work is. perf6rmecl under or pursuant•to any permit
State License Law does not apply to an owner of property who builds or improves '
issued,as a result of this application,; the,owner, and the applicant, each agrees to, and
thereon, and who contracts for the projects.with a contrador(s) licensed pursuant to.
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
the Contractors' State License Law.).
employees for any act or omission related to;the work being performed under or
(� I am exempt under Sec. B.&P.C. for this reason
following issuance of this. permit.
2. Any permit issued asaresult of this application becomes null and void if work is
>
not commenced within•180'daysfrom date of issuance.of such permit, or cessation of
Date: Owner:
work for 180.days will sutijectpermif to cancellation.
CONSTRUCTION LENDING AGENCY
I certify that I have read this application andstate that the abo a info mation is correct.
I hereby affirm under penalty of perjury that there is a construction lending agency:for
I agree to comply with all city and county ordinances -and stat laws, latin building
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
construction, and hereby authorize repiesentatives.of this city; o e e up he
above mentioned Propertyforinspection purposes.
Lender's Name:
ZZ 1
Datel Anature Si (Applicant or
Signature (PP gent)::
Lender's Address:
Date: 2/22/2017
Application, Number:
BPIOL2017-0015
Owner: .
Property Address:.
78613 PEERLESS PL
ANTHONY. DADDINO
APN-
770310020
78613"PEERLESS PL
Application Description:
DADDINO RESIDENCE / PPOL & SPA.REMODEL
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$30,000.00
Applicant:
Contractor:
DERYK AIREY
DERY.K AIREY
77571 BURRUS CT
77571 BURRUS CT
PALM DESERT, CA 92211
PALM DESERT, CA 92211
-i
(760)497-7654
Llc. No.: 962128
Detail: REMODEL EXISTING POOL AND.SPA: DOES'NOT INCLUDE REPLACEMENT OF POOL.EQUIPMENT OR EQUIPMENT WALLS. PER 2016 CALIFORNIA
BUILDING CODE
i
DESCRIPTION,-'
ACCOUNT =`
QTY
AMOUNT
BSAS SB1473 FEE',-4
'101-0000-20306
0
$2:00
"''Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$2:00
DESCRIPTION,
ACCOUNT .
" QTY
AMOUNT
GUNITE ALTERATION
. 101-0000-42404,
0 '
$190.00
DESCRIPTION
..,..ACCOUNT, -
QTY
AMOUNT
GUNITE ALTERATION PC.
101=0000=
Btn.#
City of, La Quints
Building at Safety Division
� �. P.O Box 1504, �78495 Calle Tampico
La.Qulnta, CA 92253 -:(760):777-7012
Building Permit Application' and Tracking Sheet
Penta #
lJ` _
PMjed Address: '3 L�::
' Owner's Name:. 11 s
11 7
A. P. Number.
Address:
Legal Description:
City, ST, Zip: L J t �i
Contractor.
-Telephone:
Nect Description:
Address: S� V l.: 1
City, ST, Zip M. 22"11
Telephone:? 'rAg5-4
State Lia #: Cr (02 �.Z v ; City, Lic. #'-
� c�L
SON.
Arch , Bngr., Designer. �
Address:
City, ST, Zip:
Telephone:
State Lia #:
Name of Contact Person: C-
Construction Type:. occupancy:
Project type (Circle one): New Add'n Alter Repair Demo
Sq. Ft: '
#Stories:
#Units
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WWM BELOW THIS UNE
#
Submittal
Req'd . -
'Rec'd
TRACKING
PERMIT FENS
Plan Sets
Plan Geek submitted
Iteer Amount
Stmdural Calcs.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Coles.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans piekcd up
Construction
Flood plain plan
Plana resubmitted. ,
Meeharikal
Giadiug plan
2' Review, ready for correciionsfiasue
Electrical
Subeoutaetor List
Called Contact Person
Plumbing
Grant Deed
Plans pldied up .
S.M.I.
H.O.A. Approval
Plans resubmitted
Gmdlug -
IN HOUSE:-
''",Review; ready for eorreetlons/lssae
!Developer Impact Fee
Planning Approval
Called Contact Person
AIP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees