BWFE2016-0226LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C53 License No.: 867946.x_-
Date: & Cont
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.).
(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.).
( I 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. Q.
Lender's Name:
Lender's
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 bySection 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: EXEMPT Policy Number: _
ertify that in the performance of the work for which this permit is issued, I
shanR of 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: 1 Applicant:
L
WARNING: FAIL RE TO SECURE WORK PENSATION COVERA FUL,
AND SHALL SUBJECT AN EMPLOYER T CRIMINAL PENALTIES AND S 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 this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Ag t
T 4 Q91hro
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
LA QUINTA, CALIFORNIA 92253 DESIGN
& DEVELOPMENT DEPARTMENT
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING PERMIT
te: 11/.3,/2016
Application Number: BWFE2016-0226
Owner: w
Property Address: 44030 CALICO CIR CIR
BRIAN JONES
APN: 604091034
Application Description: JONES / 60LF OF BLOCK WALL
92253 ca W
Property Zoning:
p Z
Application Valuation: $3,500.00Cj
W
/
O g a
Applicant:
''�
Contractor:a W
DESERT POOLS CONSTRUCTION
DESERT POOLS CON RUC1q@V
83370 VECINO WAY
83370 VECINO WAY CS C]
INDIO, CA 92201
INDIO, CA 92
Q
'
Q
CD
(760)578-62
Llc. No.867946 OW
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C53 License No.: 867946.x_-
Date: & Cont
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.).
(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.).
( I 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. Q.
Lender's Name:
Lender's
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 bySection 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: EXEMPT Policy Number: _
ertify that in the performance of the work for which this permit is issued, I
shanR of 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: 1 Applicant:
L
WARNING: FAIL RE TO SECURE WORK PENSATION COVERA FUL,
AND SHALL SUBJECT AN EMPLOYER T CRIMINAL PENALTIES AND S 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 this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Ag t
Date: 11/3/2016
Application Number: BWFE2016-0226
Owner:
Property Address: 44030 CALICO CIR CIR
BRIAN JONES
APN: 604091034 .
Application Description: JONES / 60LF OF BLOCK WALL
92253
Property Zoning:
Application Valuation: $3,500.00
Applicant:
Contractor:
DESERT POOLS CONSTRUCTION
DESERT POOLS CONSTRUCTION
83370 VECINO WAY
83370 VECINO WAY
INDIO, CA 92201
INDIO, CA 92201
(760)578-6281
---------------------------------------------------------------------------------------------
Llc. No.: 867946
Detail: 60LF OF 6' BLOCK WALL INSIDE EAST PL [CITY SPECIFICATIONS] PRECISION
CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR
TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING CODES.
DESCRIPTION
FINANCIAL • .
ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404 0
$50.67
DESCRIPTION
ACCOUNT CITY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600 0
$63.33
Total Paid for BLOCK WALL:
$114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
•
$5.00
••
Bin #
Permit #
Project Address:
w30
Qty of La Q uin to
Building & Safety Division
. _ 78-495 Caffe Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
6a Co 11' Owner's Name:2
A. P_ Number:
Address: 6'
Legal Description:
:
City, ST, Zip: 2
l
Contractor:
,v
ele P hone:
Address: SC-N
vin tkj
Project Description:
City, ST, Zip: '''� LQ
`�2� I
,., 0
Teleph e
TelP n 1 2
P
State Lic. # : i
City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
h
Telephone:
one:
aneY
structi n Type: Occupancy:
Con :
State L,Lic. #.
• New Add'n
0ProJeot tyPe circle ne •
AlterRepair- Dcmo
Name of Contact Person: '
1.Telephone
Nkuh
Sq. Ft.:
# Stories:
# Units:
# of Contact Perso : Z6
Estimated Value of Project: ,
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Caics.
Reviewed, ready for corrections
Plan Clieck Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"4 Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks_ APPr
Date orpermit issue
School Fees,
I
Total Permit Fees
f
CITY OF LA QUINT
13URLING & SAFETY DEPT.
FOR CONSTRUCTION
DATE EY
L
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