BPOL2015-0103LICENSED 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. 93197
Date: S (`l Conractor: Y41'
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
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).:
(_j 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 th or 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 policy 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 bec me subject to the workers'
compensation laws of California, add agree that, if I s uld beco subject to the
workers' compensation provisions of S tionA370Ohebor de, I shall forthwith
comply wi h those provisions.
Date: ) S Applic t:
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, 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 corytct.
I agree to comply with all city and county ordinances and state law relating to b ding
construction, and hereby authorize representatives of this city toter uponbove•
mentioned property for inspection purposes. / 71 /1 th
Date: Signature (Applicant or Agnt):
Twit Q"
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
.
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5 2015
Application Number:
BPOL2015-0103
Owner:
Property Address:
78395 SAND FLOWER PIL
ROMAN CATHOLIC
ISHOPOFIB
APN:
643181009
1201 E HIGHLAND
VE
Application Description:
ST. FRANCES OF ASSISI/SPA, GAS LINE AND ELECTRICAL FOR BBQ
SAN BERNARDINO,
C=)W
Property Zoning:
a
Application Valuation:
$25,000.00
g
O
t/LI`Applicant:
Contractor:v
z
A & R POOLS INC
A & R POOLS INC
P 0 BOX 103
P 0 BOX 103
LA QUINTA, CA 92247
LA QUINTA, CA 92247
(760)772-0752-'�
Uc. No.: 993197
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. 93197
Date: S (`l Conractor: Y41'
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
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).:
(_j 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 th or 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 policy 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 bec me subject to the workers'
compensation laws of California, add agree that, if I s uld beco subject to the
workers' compensation provisions of S tionA370Ohebor de, I shall forthwith
comply wi h those provisions.
Date: ) S Applic t:
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, 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 corytct.
I agree to comply with all city and county ordinances and state law relating to b ding
construction, and hereby authorize representatives of this city toter uponbove•
mentioned property for inspection purposes. / 71 /1 th
Date: Signature (Applicant or Agnt):
FINANCIAL .1.
DESCRIPTION, `-ACCOUNT 'QTY "AMOUNT , PAID y :`• PAID DATE
BSAS SB1473 FEE 101-0000-20306
0 $1.00 $0.00 '
PAID'BY - . ,`' '� - METHOD, ' ; • �
' RECEIPT CHECK#,,•
.;. . ; ;CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT,
QTY
AMOUNT
PAID..
PAID DATE
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
°PAID BY v
METHOD
_.' RECEIPT # •"''
CHECK .#
CLTD BY
DESCRIPTION '
ACCOUNT
QTY
' AMOUNT
'PAID,'' -
-PAID DATE
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
'_PAID BY
,� ` :,' +METHOD, ,r• ..
�j:. RECEIPT#
iCHECK #
CLTD BY
Total Paid for ELECTRICAL: $48.34 $0.00
DESCRIPTION -..�' '
;ACCOUNT '.'
QTY:
'` AMOUNT ; `;
PAID
PAID DATE
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
$0.00
PAID BY
METHOD,
, ;;RECEIPT #
CHECK #., .
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT .
PAID'
PAID DATE
SWIMMING POOL/SPA PC
101-0000-42600
0
$98.62
$0.00
PAID BY =,
METHOD
RECEIPT # t
.CHECK # , °'.
CLTD BY
Total Paid forPOOL / SPA: $279.91 $0.00
TOTALS:
'v
'
A
•
Permit Details PERMIT NUMBER
o
City f La Quinta
t
v
BPOLtr201� 10:3
Description: ST. FRANCES OF ASSISI/SPA, GAS LINE AND ELECTRICAL FOR BBQ
Type: POOL Subtype: Status: APPROVED
Applied: 5/19/2015 SKH
Approved:
Parcel No: 643181009 Site Address: 78395 SAND FLOWER PL LA QUINTA,CA 92253
Subdivision: TR 2117 Block: Lot: 46
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $25,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories- 0 No. Unites: 0 .
:• s«w `COMPLETION DATE NOTES'^
Details: ADD SPATP EXISTING POOL AND REPLASTER. NEW GAS AND ELECTRICAL FOR FUTURE BBQ. PERMIT DOES NOT INCLUDE WALL.
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
Printed: Tuesday, May 19, 2015 2:11:38 PM 1 of 2 C
SYS iEMS
ADDITIONAL
1-7
z. "CHRONOLOGY TYPE ' ` 'STAFF NAME ; `:
ACTION DATE
:• s«w `COMPLETION DATE NOTES'^
.
NOTE
PHILIP JUAREZ
5/19/2015
5/19/2015
sent back to philip
CONDITIONS
yNAME TYPE
'r :NAME ''
9 ADDRESSI . y
CITY."e STATE
ZIP
%PHONE .-
FAX'
x EMAIL
_
APPLICANT
A & R POOLS INC
P O BOX 103
LA QUINTA CA
92247
CONTRACTOR
A & R POOLS INC
P O BOX 103
LA QUINTA CA
92247
OWNER
ROMAN CATHOLIC BISHOP OF SB
1201 E HIGHLAND AVE
SAN CA
92253
BERNARDINO
FINANCIAL INFORMATION
Printed: Tuesday, May 19, 2015 2:11:38 PM 1 of 2 C
SYS iEMS
5
OF
SEQID �- INSPECTION•TYPE ,- • "INSPECTOR . `; 'SCHEDULE D' COMPLETED j INSPECTIONS
.RESULT-.- REMARKS'
K , E +� y
.. DATE . DATE %
�w ry
r.
FINAL" BLD
,.PARENT PROJECTS
Printed: Tuesday, May 19, 2015 2:11:38 PM 2 of 2 CR
SYSTEMS
r . 'ACCOUNT-.
'.•QTY
AMOUNT•
PAID'
PAID DATE
RECEIPT.#
;CHECK # .,.
METHOD
PAID BY
FLT•DESCRIPTION
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00,
BSA:
DEVICES, FIRST 20
101-0000-42403
0.
$24.17
$0.00
DEVICES, FIRST 20 PC
101-000042600 '
0
$24.17
$0.00
Total Paid for ELECTRICAL: $48.34 $0.00
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
$0.00
SWIMMING POOL/SPA
101-0000-42600
0
$98.62
$0.00
PC
Total Paid for POOL / SPA: $279.91 $0.00
TOTALS:00
SEQID �- INSPECTION•TYPE ,- • "INSPECTOR . `; 'SCHEDULE D' COMPLETED j INSPECTIONS
.RESULT-.- REMARKS'
K , E +� y
.. DATE . DATE %
�w ry
r.
FINAL" BLD
,.PARENT PROJECTS
Printed: Tuesday, May 19, 2015 2:11:38 PM 2 of 2 CR
SYSTEMS
Iain #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.
3 Building Permit Application and Tracking Sheet
Permit #
p 20 « (D1
Project Address: 3Q15-„jo P10L jJt�_ PL
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:' ff -- 11��
L.F� Dlit✓ +o
Contractor: G..
l
Telephone:
hone•
2
Address: �o )D3
Project Description:
City, ST, Zip: C 221.1
Poo -1 MOLL
1
Telephone: hone• 7
� a 5 a-
:::.:::::::::::.:::.;:::;:.:.:
,
o� Q 0 ,
State Lic. # : 3 197
City Lic.:.#
�
Arch., Engr., Designer:
at, -
Address:
City, ST, Zip:
Telephone:
Construction T anc
Type:, Occupancy:
Y•
State Lic. #
o1Pr' ect type (circle one): New A d' n Alter Repair Demo
Name of Contact Person: M U k ed l e— L
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: J5 DD0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
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.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' 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
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TYIDT LA QUINTA
ILDIN6 & SAFETY DEPT:
APPROVE®
FO CONSTRUCTION