BPOL2016-0053(760)322-7665
Llc. No.: 802919
LICENSED CONTRACTOR'S DECLARATION a4, WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I 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: C53 License No.: 802919
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
he or she did not build or improve for the purpose of sale.).
(� 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.).
(_) 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
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 polity 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, DAMAGESAS 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 this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
C�'
VOICE (760) 777-7125
78-495 CALLE TAMPICO
0 D
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/23/2016
Application Number:
BPOL2016-0053
Owner:
Property Address:
81655 PRISM DR
DEBRA FARRIS
APN:
76438/042
81655 PRISM DRIVE
Application Description:
FARRIS/ POOL, SPA, FIRE PIT AND 12LF BLOCK WALL AT REAR YARD
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$17,500.00
Applicant:
Contractor:
AZURE POOLS & SPAS.INC
AZURE POOLS & SPAS INC
P 0 BOX 10641.
P 0 BOX 10641
PALM DESERT, CA 92255
PALM DESERT, CA 92255
(760)322-7665
Llc. No.: 802919
LICENSED CONTRACTOR'S DECLARATION a4, WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I 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: C53 License No.: 802919
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
he or she did not build or improve for the purpose of sale.).
(� 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.).
(_) 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
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 polity 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, DAMAGESAS 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 this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
FINANCIAL .•
/.
' DERIP.TION' °
SC
r ° ACC OLIN T `'
sQTY AMOUNT.
PAID _ : -
PAID DATE
BSAS SB1473 FEE-
101-0000-20306
0 $1.00
$1.00
5/3/16
PAID BYs .
k METHOD
RECEIPT #
" :CHECK #
CLTD BY
renee frye
CREDIT
WEB758
2016050322021802034
ECON
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00
DESCRIPTION,: p x
ACCOUNTk'
;QTY $
'" AMOUNT'
:- PAID`
PAID DATE
Credit Card Fee
101-0000-43505
0
$9.37
$9.37
5/3/16
p PAID BY
' r`.," '
METRECEIPT-#.
; :; HOD. h .
RECEIPT #
�e ..
CHECK # ; o -,
_CLTD BY
renee frye
CREDIT
WEB758
2016050033242021802
ECON
Total Paid for Credit Card Fee-. $9.37 $9.37
Y
'DESCRIPTION,:,w;
Jj
£'`* ACCOUNT
QTY,
iY
PAID ``t
PAID GATE
9�
FAMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$47.86
$47.86
5/3/16
,
` PAID BY { n:
'k ; METHOD R
RECEIPT # E ' ti
CHECK # q
. LLTD BY
renee frye
CREDIT
WEB758
201605 021802'
ECON
034
DESCRIPTION '-'
t r ACCOUNTQTY,
F : AMOUNT •
t PAID
=PAID DATE'
x;
,
WALL/FENCE - FIRST 100 LF PC
101-0000-42600.
0
$60.91
$60.91
5/3/16
PAID -BY
METHOD. a�°rRECEIPT
#•
CHECK# �'
CLTD-BY-
��
renee frye
CREDIT
WEB758
20160500334 021802
ECON
Total Paid for FENCE OR FREESTANDING WALL: $108.77 '$108.77
DESCRIPTION, s
ACCOUNT';
QTY
` : AMOUNT.'." ,.
E e . `' PAID °.
PAID DATE`
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.09.
$12.09
5/3/16
:4 ; PAIOBY � ° � '
�' � �' METHOD + �
�`� c�„RECEI?T # �”
� 'CHECK #
' l_TD'BY
renee frye
-CREDIT
WEB758
20160500334
ECON
021802
' :
` Y4"a-QT
ACCOUNT
AMOUNTDESCRIPTION.,
` PAID
PAID DATE
f
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0.
$24.17
$24.17
5/3/16
•� PAID BY ::''
r'a ' METHOD
r
,:''RECEIPT,#
eF CHECK #
' {LTD'BY
r
x.
, _
renee frye
CREDIT
WEB758
201605 021802
ECON
034
Total Paid for PLUMBING FEES: $36.26 $36.26
t, DESCRIPTION
ACCOUNT t' .
QTY t
"; ., AMOUNT
PAID . ;
PAID DATE
SWIMMING POOL/SPA
101-0000-42404
0
$181.29 '
$181.29
5/3/16
PAID BY,
METHOD : ,
%RECEIPT # c,
CHECK # , -
CLTD BY',i`
renee frye
CREDIT
WEB758
2016050033
ECON
2021802
DESCRIPTION etc -
ACCOUNT
QTY-�
AMOUNT°
=PAID
PAID DATE.
.a
SWIMMING POOL/SPA PC •
101-0000-42600
0
$98.62
$98.62
5/3/16
`+ `` PAID BY ,
METHOD
,RECEIPT #
: CHECK #
CLTD BY
renee frye
CREDIT 1 WEB758 2016050034 0218021 ECON
Total Paid for POOL / SPA: $279.91 $279.91
Description: FARRIS/ POOL, SPA, FIRE PIT AND 12LF BLOCK WALL AT REAR YARD
Type: POOL CONSTRUCTION Subtype: PRIVATE Status: ISSUED
Applied: 4/22/2016 ECON
(WEB)
Approved: 4/25/2016 JFU
Parcel No: 764380042 Site Address: 81655 PRISM DR LA QUINTA,CA 92253
Subdivision: TR 30023-2 Block: Lot: 148
Issued: 5/3/2016 ECON
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $17;500.00 Occupancy Type: Construction Type:
Expired: 12/4/2016 crw
No. Buildings: 0 No. Stories: 0 No. Unites: 0
CHRONOLOGY TYPE STAFF NAME
'ACTION DATE
CONIPLETION-DATE :
Details: POOL, SPA, FIRE PIT AND 12 LF OF 4' HIGH BLOCK WALL EQUIPMENT ENCLOSURE AT REAR YARD [POOL ENGINEERING INC.].
ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE. .....,I Applied to Approved
Approved to Issued `
FINANCIAL INFORMATION
Printed: Thursday, lune 23, 2016 9:47:09 AM 1 of S ®®
SYSTEMS
ADDITIONAL
CHRONOLOGY
CHRONOLOGY TYPE STAFF NAME
'ACTION DATE
CONIPLETION-DATE :
-
NOTES
E-MAIL JAKE FUSON
4/25/2016
4/25/2016
NOTIFIED RENEE WITH AZURE POOLS THAT PLAN WAS
APPROVED AND PERMIT WAS READY TO ISSUE.
CONDITIONS
CONTACTS,
NAME TYPE
NAME -
ADDRESSI
CITY
STATE
ZIR
PHONE
FAX .;
EMAIL '
APPLICANT
AZURE POOLS & SPAS INC
P 0 BOX 10641
PALM DESERT
CA
92255
(817)545-1056
RENEE@AZUREPOOLSA
NDSPAS.COM
CONTRACTOR
AZURE POOLS & SPAS INC
P O BOX 10641
PALM DESERT
CA
922S5
(817)5454056
RENEE@AZUREPOOLSA
NDSPAS.COM
OWNER
DEBRA FARRIS81655
PRISM DRIVE
LA QUINTA
CA
92253
(817)545-1056
SUZYFARRIS@GMAIL.0
OM
FINANCIAL INFORMATION
Printed: Thursday, lune 23, 2016 9:47:09 AM 1 of S ®®
SYSTEMS
Printed: Thursday, June 23, 2016 9:47:09 AM 2 of 5 CRSYSTEMS
"T77
7'
CLTD
ION
"*".DESCRIPTrK
-ACCOUNT
��!�-
,.AMOUNT
v-,.,
14PAID
PAID DATE.
-,RECEIPT #
METHOD
PAID BY
BY,a:
201605032
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
5/3/16
WEB758
202180203
CREDIT
renee frye
ECON
4
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
201605032
Credit Card Fee
101-0000-43505
0
$9.37
$9.37
5/3/16
t
WEB758
202180203
CREDIT
renee frye
ECON
4
Total Paid for Credit Card Fee: $9.37 $9.37
WALL/FENCE - FIRST
201605032.
101-0000-4240
0
$47.86
$47.86
.5/3/16
WEB758
202180203
CREDIT
renee frye
ECON
100 LF
4
WALL/FENCE - FIRST
201605032
101-0000-42600
0-
$60.91
$60.91
5/3/16
WEB758
202180203
CREDIT
renee frye
ECON
100 LF PC
4
Total Paid for FENCE OR FREESTANDING WALL: $108.77 $108.7.7
201605032
GAS SYSTEM, 1-4
101-0000-42401
0
$12.09
$12.09
5/3/16
WEB758.
202180203
CREDIT
renee frye
ECON
OUTLETS
4
201605032
GAS SYSTEM, 1-4
101-0000-42600
0
$.24.17
5/3/16
WEB758
202180203
CREDIT
renee frye
'ECON
OUTLETS PC
.$24.17
4
Total Paid for PLUMBING FEES: $36.26 $36.26
201605032
SWIMMING POOL/SPA
101-0000-424040
$181.29
$181.29
5/3j16
WEB758
202180203
CREDIT
renee frye
ECON
4
Printed: Thursday, June 23, 2016 9:47:09 AM 2 of 5 CRSYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE.
RECEIPT #
CHECK # ..
METHOD
PAID BY
CLTD
COMPLETED RESULT
REMARKS
""" .:. NOTES ....
DATE
DATE
BY
SWIMMING POOL/SPA
5/3/2016 3:06 PM AZURE POOLS & SPAS INC
201605032
101-0000-42600
0
$98.62
$98.62
5/3/16
WEB758
202180203
CREDIT
renee frye
ECON
PC
Request
Phone:7603227665
e -Mail: RENEE@AZUREPOOLSANDSPAS.COM
4
Total Paid for POOL / SPA: $279.91 $279.91
TOTALS: $435.1i $435.31
Printed: Thursday, June 23, 2016 9:47:09 AM 3 of 5
srsrenns
INSPECTIONS
SEQID
INSPECTION TYPE
INSPECTOR
SCHEDULED
COMPLETED RESULT
REMARKS
""" .:. NOTES ....
DATE
DATE
5/3/2016 3:06 PM AZURE POOLS & SPAS INC
Contact Name: AZURE POOLS & SPAS INC
PRE-GUNITE
JFU
5/4/2016
5/4/2016
APPROVED
eTRAKiT Inspection
Site Address:. 81655 PRISM DR
Request
Phone:7603227665
e -Mail: RENEE@AZUREPOOLSANDSPAS.COM
FROM POOL EQUIPMENT LOCATION TO
POOL LIGHTING TO THE'SOUTH-EAST
UNDERGROUND ELEC
JFU
5/4/2016
5/4/2016
PARTIALLY
CORNER OF HOUSE ONLY. SECOND.
APPROVED
INSPECTION REQUIRED FOR CONDUIT FROM
PANEL TO SOUTH-EAST CORNER OF HOME.
FROM POOL EQUIPMENT LOCATION TO FIRE
PIT TO THE SOUTH-EAST CORNER OF HOUSE
UNDERGROUND GAS
JFU
5/4/2016
5/4/2016
PARTIALLY
ONLY. SECOND INSPECTION REQUIRED FOR
APPROVED
PIPING FROM METER LOCATION TO SOUTH-
EAST CORNER OF HOME.
UNDERGROUND PLBG
JFU
5/4/2016
5/4/2016
APPROVED
Printed: Thursday, June 23, 2016 9:47:09 AM 3 of 5
srsrenns
UNDERGROUND GAS JFU 5/10/2016 5/10/2016 APPROVED eTRAKiT Inspection
Request
UNDERGROUND ELEC JFU 5/10/2016 5/10/2016 APPROVED
I . I DECK BOND . I JFU I 6/7/2016 I 6/7/2016 I APPROVED
PARENT PROJECTS
5/9/2016 1:15 PM AZURE POOLS & SPAS INC
PLS INSPECT UNDERGROUND ELEC & GAS
FROM MAIN TO POOL. GAS & ELEC HAVE
BEEN INSPECTED FROM POOL TO EQUIP
LOCATION.
Contact Name: AZURE POOLS & SPAS INC
Site Address: 81655 PRISM DR
Phone:7603227665
e -Mail: RENEE@AZUREPOOLSANDSPAS.COM
COMPLETE UG GAS APPROVAL. ALL GAS
PIPING FROM METER TO ALL GAS OUTLETS
COMPLETE, TESTED AND INSPECTED.
COMPLETE APPROVAL. INCLUDES ALL
CONDUIT FROM PANEL TO POOL LIGHTS TO
. EQUIPMENT LOCATION.
-
BOND INFORMATION
Attachment Type
CREATED
OWNER
ATTACHMENTS
DESCRIPTION
PATHNAME
SUBDIR
ETRAKIT ENABLED
DOC
4/22/2016
EtrakitContractor
HOA APPROVAL LETTER
Scan1.PDF
1
DOC
4/22/2016
EtrakitContractor
ENGINEERING - FIELD
VERIFICATION
REQUIRED
Scan10001.PDF
1
Printed: Thursday, June 23, 2016 9:47:09 AM 4 of 5
(r7SYS7EMS
AlTACHMENTS
Attachment.Type�'
CREATED -;`#
i'
OWNER
DESCRIPTION
r- PATHNAM'E "'W':
Y `;"SUBDiR m° °ETRAKIT=:ENABLED.:
BPOL2016-0053 -
DOC
4/25/2016
JAKE FUSON
APPROVED POOL PLAN
APPROVED POOL
1
PLAN.pdf
BPOL2016-0053 -
DOC
4/25/2016
JAKE FUSON
APPROVED WALL
APPROVED WALL
1
DETAIL
DETAIL.pdf