BPOL2016-0157LICENSED 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 ClassiC-8, C10, C29, C53, C27, D12 Lice)ise No.: 656128
r OWNER -BUILDER DECLARA N .
I hereby affirm under penalty of perjury that I am a pt 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).:
(_) 1, 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 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:
(760)389-9222
Llc. No.: 656128
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
ofyife for which this permit is issued.
, I have and will maintain workers' compensation insurance, as required by
tion 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: STARSTONE NATIONAL INSURANCE COMPANY Polity 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 1 should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those rovisions.
Date%% t7 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMP/ALTIITES
COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINALAND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000).N 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 operty for inspection purposes.
Dat Q Signature (Applicant or Agent
78-495 CALLE TAMPICO
D
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX
FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT
(760) 777-7153
BUILDING PERMIT
Application Number:
BPOL2016-0157
Owner:
Property Address:
54875 DAMASCUS WY
LENNAR HOMES
APN:
767790059
54875 DAMASCUSo
c o0
Application Description:
LENNAR /POOL SPA AND BBQ
LA QUINTA, CA 92253
S Yz
Property Zoning:
C3 LU
Application Valuation:
$30,000.00
o d
Applicant:
Contractor:
CJ
v
TESERRA
TESERRA
P 0 BOX 1280
P 0 BOX 1280
$
COACHELLA, CA 92236
COACHELLA, CA 92236
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 ClassiC-8, C10, C29, C53, C27, D12 Lice)ise No.: 656128
r OWNER -BUILDER DECLARA N .
I hereby affirm under penalty of perjury that I am a pt 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).:
(_) 1, 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 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:
(760)389-9222
Llc. No.: 656128
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
ofyife for which this permit is issued.
, I have and will maintain workers' compensation insurance, as required by
tion 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: STARSTONE NATIONAL INSURANCE COMPANY Polity 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 1 should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those rovisions.
Date%% t7 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMP/ALTIITES
COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINALAND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000).N 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 operty for inspection purposes.
Dat Q Signature (Applicant or Agent
Date: 10/25/2016
Application Number.
.BP,OL2016-0157
Owner:
Property Address:
54875 DAMASCUS WY
LENNAR HOMES
APN:
767790059
54875 DAMASCUS
Application Description:
LENNAR / POOL SPA AND BBQ
LA QUINTA; CA 92253
Property Zoning:
Application Valuation:
$30,000.00
Applicant:
Contractor:
TESERRA
TESERRA
P 0 BOX 1280
P 0 BOX 1280
COACHELLA, CA 92236
COACHELLA, CA 92236
(760)389-9222
Llc. No.: 656128
Detail: POOL, SPA, AND BBQ. EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH MANUFACTURER SPECIFICATIONS. ALARMS AND BARRIERS '
REQUIRED TO BE INSTALLED AT PRE-PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE.
FINANCIAL INFORMATION
"• r °• ° r DESCRIPTIONACCOUNT CITY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20.13C
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SWIMMING POOL/SPA
101-0000-42404
0
$190.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SWIMMING POOL/SPA PC
101-0000-42600
0
$103.36
Total Paid for POOL/ SPA: $293.36
Bin #f
Permit #{
?fDQ010'-La
��
Project Address: _ /
,.City of La Quinto
Building 8i Safety Division
. . 78-495 Calle Tampico
Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Owner's Name: `-
A. P. Number:
Address: S�E'Y_
Legal Description:
City, ST, Zip -.
Contractor:
r
Telephone:
AddressProject
Description:
City, ST, Zip:
Tele h e
P on
State Lie. # :10,5-1,e
City Lie.
Arch.,'Engr., Designer:
Address:
City, ST, Zip:
Telephone: hone.
n TY aneY
Construction e• Occupancy:
P :
,.
State to Lic. # •Pr
Jectty P circle one • New Add'n Alter Repair Demo,
Name of Contact Person: U "��
Sq. Ft.:
# Stories:
# Units:
Telephone# of Contact Person:
Estimated Value of Project: 30 e0o' 190
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Cafes.
Plans picked up
Construction '
Flood plain 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 resubmitted
Grading
IN IIOUSE:-
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.
- 11 Iran
Total Permit Fees
OCT 2 4 2016
CIN OF LA QUINTA
COMMUNITY pEVELOPMENT