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BPOL2015-0112LICENSED 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, C27 License No.: 823017 Date: —�/ Contractor.�r, 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 thanfive: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 Iice nsed,contractors to constructithe 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 Nam Lender's WORKER'S COMPENSATION DECLARATION I hereby affirm under penaltyof'' i - 'ry one of the following declarations: I•have and_will maintain'a certificate of consent to self -insure for workers' compensation,;as provided for.by'Section3700 of;the Labor Code, for the performance of the work for.which this permit is issued. b'have and will maintain workers' compensation insurance, as required by Section 3200 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:_ 'PolicyNumber: 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' coiripensationprovisions of Section 3700 of.the Labor Code, I shall forthwith comply with those:rrovisions. ZD Date: /: 1 Applicant: WARNING: FAILURE;TO'SECLIRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBIECT 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. f APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby,made.to-theEBuilding Official for a permit subject to the conditionstand restrictions set forth on this application. 1. Each person,upon whose behalfthis application is made, each person at whose requesCand:for whose berieft work is;performed under or pursuant to any permit i.ssu'e'd.as a result,of thisapplication,, 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 oinission related to the work being performed under or follo%�iing issuance of this permit. 2. Anypermit,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'1'80 days will subjectpermit to cancellation. I certify.that I have read this application and state that,the above information is correct. I= 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. Dater/ Signature (Applicant or Agent): ✓ n. "'"' _ VOICE(760)777-7125 78-495 CALLE Tf1MPiC0'"� d-0... •' w, .. :;;,:.._::, . FAX (760) 777-7011COMMUNITY LA QUINTA, CALIFORNIA 92253 DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING�PERMIT ' Date:. 6/2/2015 Application Number: BPOL2015-0112 Owner: Property Address: 44640 CALLE SANTA :BARBARA •'BENJAMIN VANSKIK cu APN: 604381004 44640 CALLE SANTA Application Description: VANSKIKE RESIDENCE POOL &' SPA LA QUINTA, fC '9225 F Property Zoning: r—=3 r°• Application Valuation: $18,000.00. C=) g Applicant: Contractor: Q' z MCRAE POOLS& SPAS MCRAE•POOLS & SPAS 79 105 DESERT STREAM DRIVE 79 105 DESERT STREA DRIVE LA QUINTA, CA 92253 LA QUINTA, CA -92253 " • (760)774-6343 Llc. No.: 823017 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, C27 License No.: 823017 Date: —�/ Contractor.�r, 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 thanfive: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 Iice nsed,contractors to constructithe 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 Nam Lender's WORKER'S COMPENSATION DECLARATION I hereby affirm under penaltyof'' i - 'ry one of the following declarations: I•have and_will maintain'a certificate of consent to self -insure for workers' compensation,;as provided for.by'Section3700 of;the Labor Code, for the performance of the work for.which this permit is issued. b'have and will maintain workers' compensation insurance, as required by Section 3200 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:_ 'PolicyNumber: 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' coiripensationprovisions of Section 3700 of.the Labor Code, I shall forthwith comply with those:rrovisions. ZD Date: /: 1 Applicant: WARNING: FAILURE;TO'SECLIRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBIECT 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. f APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby,made.to-theEBuilding Official for a permit subject to the conditionstand restrictions set forth on this application. 1. Each person,upon whose behalfthis application is made, each person at whose requesCand:for whose berieft work is;performed under or pursuant to any permit i.ssu'e'd.as a result,of thisapplication,, 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 oinission related to the work being performed under or follo%�iing issuance of this permit. 2. Anypermit,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'1'80 days will subjectpermit to cancellation. I certify.that I have read this application and state that,the above information is correct. I= 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. Dater/ Signature (Applicant or Agent): :-A Ci gigs.0 g T WSB1473.FEE 101-0 0- 1,00 00' ,,AIDJBW, '#€iblyII;axR SE NM IMP P Jotal Paid"forBUILDING STAN DARDS?ADM IN ISTRAT ION.,BSA- 0 .$9.00 4vswow—m*wt�ygS MlMt NNER- nUOWME`r4x Mwlmy,-.,�.�,-,— 4-1— ACCOUNTS m �rv�N ,4 VIOUNTV F-R."M RM11-1-i'VEMOV.4; T E. 0 SWIMMING P OL/Sp 101-'0000- 42 0. 91- u.od Comm t mml RECEIF,rj-f �.l I MW VIA, MiX4. DESCRIPTION aEAMOUNT MIMI' N, W;,?PIV QTlY- .a10 �.i WT -w- QR�, ODI� Qs, VAIMDATE 4=7, SWIMMING. PoOL/spA Oc • 101OQRP,42600�, ! 0, 000 "ACM MAM-1 N', g ra � rim m.l. .ism wkp�! ;M. -, METHOD, ".,; - �021111! 'IRECEIVRNPOCK C. E( :7 afPaid fo' POO rU/...,,..SPA5279`91 $0 -0 R hb aplS- D I Bin # Clay of`La Quinta, Building 8t Safety; Dn%ision , P.O'Box 150.4, 78'495 Gaffe -Tampico Permit # �• La Qurnta, CA 92253 (760) 77T70 t 2 4-4&• 0 "Building Perm+t Applicatron Viand Tracking Sfieet Project Address: 1 Owner s;Name A. P. Number.'� . , e .. Address: . %yyI ` L�16 . i 'City ST,:Zip: LA !J Legal Description: _ 8 P Contractor.pA �. f�� 1.^ Telephone; Rs -0x,s. . Address: iM DR ProjectDescription:'-SPAN 41Que City, ST, Zip: Telephone: ; 7 631 City Lia C Stats Lic. # : Q Arch., Engr., Designer Address: " City., ST, Zip: . z , . F . Telephone: '' a ;�Construction;Type:. Occupancy: State Lie. #: t� ::r, < . •.. ; Project type (circle one): 'New Add n Alter Repair Demo Name of Contact Person:Q '�'• M C H C' n ',Sq Ft_: Stories: # Units: Telephone # of Contact Person: 7 6% Estimated Value of Project: Q; APPLICAIIET: DO NOT WRITE'BELOW THIS.UNE # Submittal RC9'd Reed TRACMG_ PERMLT.FEFS Plan Sets Pian Checksttbmitted r 5 . Item Amount Structural Cales. Reviewed, reiidyfor corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance Title 24 Cala. Plans picked up 4 Canstrdcdon Flood plain plea Plansresubmitted i "Mechanical Grading plan - 2'd Review, ready,for rnrrectioasfissue Electrical Subcontactor. List CallMfontactPerson s<. Plumbing Grant Deed Plans picked up S.M.I. l H.O.A. Approval ':Plans resubmitted • Grading IN HOUSE:- 3'" Rgvicw, ready for correctionsfissuc Developer impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue School Fees " .Total Permit Fees Description: VANSKIKE RESIDENCE POOL & SPA Type: POOL Subtype: Status: APPROVED Applied: 6/2/2015 MFA Approved: 6/2/2015 KKI Parcel No: 604381004 Site Address: 44640 CALLE SANTA BARBARA LA QUINTA,CA 92253 Subdivision: TR 25953 Block: Lot: 12 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $18,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: POOL & SPA. EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH MANUFACTURER SPECIFICATIONS. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE. Printed: Tuesday, June 02, 2015 3:31:13 PM 1 of 2 SYSTEMS ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE'" ' °, STAFF NAME ACTION DATE, COMPLETION DATE NOTES PLAN CHECK SUBMITTAL MARY FASANO 6/2/2015 6/2/2015 sent back to mary RECEIVED CONDITIONS ZIP �� ;`PHONE-� FAX '' EMAIL .- �. NAME TYPE `NAME.ADDRESSI CITY . " STATE APPLICANT MCRAE POOLS & SPAS 79105 DESERT STREAM LA QUINTA CA 92253 DRIVE CONTRACTOR MCRAE POOLS & SPAS 79105 DESERT STREAM LA QUINTA CA 92253 DRIVE OWNER BENJAMIN VANSKIKE 44640 CALLE SANTA LA QUINTA CA 92253 BARBARA Printed: Tuesday, June 02, 2015 3:31:13 PM 1 of 2 SYSTEMS PARENT PROJECTS BOND INFORMATION ATTACHMENTS Printed: Tuesday, June 02, 2015 3:31:13 PM 2 of 2 SYSTEMS