BPOL2016-0159LICENSED CONTRACTOR'S 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.: 878257
Date: L/ / 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 Name:
Lender's Address:
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 wo for which this permit is issued.
ave and will maintain workers' compensation insurance, as required by
Sefction1700 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9099738
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' MPENSATION 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, 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 en r upon the
above-mentioned property for inspection purposes.
Date: �b Signature (Applicant or Agent):
V
VOICE (760) 777-7125
78-495 CALLE TAMPICO
U
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS
(760) 777-7153
BUILDING PERMIT
Date: 11/2/2016
Application Number: BPOL2016-0159
Owner:
Property Address: 81105 COLUMBUS
EAST OF MADISON
APN: 767670028
P 0 BOX 1482
Application Description: WATER WALL FEATURE AND FIRE PIT
LA QUINTA, CA 0
Property Zoning:
Application Valuation: $30,000.00
n
0
5
Applicant:
Contractor:
z
BRILLIANT POOLS DBA PREMIER POOLS & SPAS
BRILLIANT POOLS DBA
P9LS SP
P O BOX 429
P O BOX 429
m o
D
YUCCA VALLEY, CA 92286
YUCCA VALLEY, CA 92 S
•
z o
its
(760)333-0187
0
o
Llc. No.: 878257
O
r
vi
-------------------------------
------------------------------
-- ---- - - - - - -
- - - --
--
LICENSED CONTRACTOR'S 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.: 878257
Date: L/ / 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 Name:
Lender's Address:
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 wo for which this permit is issued.
ave and will maintain workers' compensation insurance, as required by
Sefction1700 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9099738
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' MPENSATION 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, 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 en r upon the
above-mentioned property for inspection purposes.
Date: �b Signature (Applicant or Agent):
V
Date: 11/2/2016
Application Number:
BPOL2016-0159
Owner:
Property Address:
81105 COLUMBUS
EAST OF MADISON
APN:
767670028
P O BOX 1482
Application Description:
WATER WALL FEATURE AND FIRE PIT
LA QUINTA, CA 0
Property Zoning:
Application Valuation:
$30,000.00
Applicant: Contractor:
BRILLIANT POOLS DBA PREMIER POOLS & SPAS BRILLIANT POOLS DBA PREMIER POOLS & SPAS
P 0 BOX 429 P 0 BOX 429
YUCCA VALLEY, CA 92286 YUCCA VALLEY, CA 92286
(760)333-0187
Llc. No.: 878257
Detail: POOL WATER FEATURE ONLY PER ENG. PLANS [TODD L. LACHER] & 2013 CBC CODES
C
FINANCIAL
DESCRIPTION
•• •
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DETACHED SPA/WATER FEATURE/OTHER
101-0000-42404
0
$190.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SWIMMING POOL/SPA.
101-0000-42404
0
$190.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SWIMMING POOL/SPA PC
101-0000-42600
0
$103.36
Total Paid for POOL / SPA:
TOTALS:4:
$483.36
Bill ## Qty of La Q uIn td
Building 8t Safety Division
Permit ## . " 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
3�(� �� D IS% Building Permit Application and Tracking Sheet
Project Address: O /CJ�In� �� Owner's Name: 1.X r'- qr o td leA,
A. P. Number:
Address:
Legal Description:
City,ST, ZiP:
Contractor: ,4^ t/
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Tele hoot:
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Address: f .O ok floc
Project Description: /� �W �
City, ST, Zip: ! 1JCCrr i�� he �Idoi
Telephone:' -)&0 --U
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State Lic. # :
City Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
eY�TelePhone:
an
Cons fractionTY Occupancy:
Type:
,
State. Lic. #,
Project (circle ne • New Add'n Alter Repair. Demo
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Name of Contact Person: JQSUn �, Wt�
Sq. Ft":
# Stories:
# Units:
Telephone # of Contact Person:
�%0 3 �' 3- o/d
Estimated Value of Project: �ti, p o O
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Pians picked up
Construction
Floodplain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I. ,
II.O.A. Approval
Plans resubmit?ed
Grading
IN ROUSE.:-
Jrd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks" Appr
Date of permit issue
School Fees,
Total Permit Fees
Page 1of1
61111 - • - - •
November 1, 2016
Mr. Jason Lewis
Brilliant Pools
58650 Sun Mesa Dr
Yucca Valley, CA 92284
Re: Clarification on water feature design for
81105 Columbus Way, La Quinta, CA 92253-5545
Dear Mr. Lewis:
It is my understanding that clarification is required concerning the water feature design
provided by Pool Engineering, Inc. for use at the above referenced project.
Please be advised that the water feature as detailed on Pool Engineering, Inc. sheet WR1 has
been designed to be fully self-supporting and structural independent from the adjacent
residence wall and foundation. The water feature structure has been designed to resist
applicable seismic and wind loading in accordance with the California Building Code.
If you require any additional information please feel free to contact me.
Best Regards,
Q�pFESSIp "Y
P oi. ne' a ing, Inc. �oV. F
W C 67656 m
CC
EXP. 613012017
odd Lacher, E.
`P
Senior EngineerI
oFcA��F�`'
I CIT' OF LA QUINTA
I 13UILDING & SAFETY DEFT.
FOR CONSTRUCTION
1201 N. Tustin Avenue, Anaheim, California 92807 Fax: (714) 630-6114 Phone: (714) 630-6100
C