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BPOL2015-0091LICENSED 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, C27 License No.: 823017 :DatContractor: C � i 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 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.jAy workers' compensation insurance carrier and policy number are: Carr' r: 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 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: —r^//" �5 Applicant: 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 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 Agent): VOICE (760) 777-7125 . 78-495 CALLE TAMPICO D FAX (760) 777-7011IA LA QUINTA, CALIFORN92253. COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153' BUILDING PERMIT Date: 5/11/2015 • Application Number: BPOL2015-0091 Owner: Property Address: 79949 INDEPENDENCE WAY JEFFREY TILLIE APN: 604503007 79949 INDEPENDENCE c) Application Description: TILLIE / POOL, SPA, AND FIRE PIT LA QUINTA, CA 92253 v Property Zoning: z Application Valuation: $22,000.00 o C) 'i oM Applicant: Contractor: -n h-+ � � MCRAE POOLS & SPAS MCRAE POOLS & SPAS ft F,,, y S ` ry 79 105 DESERT STREAM DRIVE 79 105 DESERT STREAM DRIVE m C= O a LA QUINTA, CA 92253 LA QUINTA, CA 92253 32 crt (760)774-6343 z r� —' 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 7000) 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 :DatContractor: C � i 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 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.jAy workers' compensation insurance carrier and policy number are: Carr' r: 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 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: —r^//" �5 Applicant: 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 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 Agent): l • FINANCIAL DESCRIPTION • ACCOUNT J, QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY, METHOD RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT. QTY AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forPLUMBING FEES: $36.26 $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 # CHECK # CLTD BY Total Paid for POOL / SPA $279.91 $0.00 TOTALS:$0.00 - Permit Details PERMIT NUMBER City of La Quinta BPOU 15=0091 w Description: TILLIE / POOL, SPA, AND FIRE PIT Type: POOL . Subtype: Status: APPROVED Applied: 5/7/2015 SKH Approved: 5/11/2015 MFA Parcel No: 604503007 Site Address: 79949 INDEPENDENCE WAYLA QUINTA,CA 92253 Subdivision: TR 24197-3 Block: Lot: 52 Issued: Lot Scl Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $22,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 CITY Details: NEEDS BUSINESS LICENSE ZIP .POOL, SPA, FIRE PIT, [2 INCH GAS PIPING/#8 AWG IN 1 INCH CONDUIT ELECTRICAL] SHALL BE INSTALLED IN ACCORDANCE WITH MANUFACTURER SPECIFICATIONS. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE. APPLICANT Printed: Monday, May 11, 2015 8:41:07 AM 1 of 2 CR?WlYSTEMS ?I CONTACTS NAME TYPE - NAME ADDRESSI CITY STATE ZIP PHONE. FAX EMAIL APPLICANT MCRAE POOLS & SPAS 79 105 DESERT STREAM LA QUINTA CA 92253 DRIVE CONTRACTOR MCRAE POOLS & SPAS 79 105 DESERT STREAM LA QUINTA CA 92253 DRIVE OWNER JEFFREY TILLIE 79949 INDEPENDENCE I LA QUINTA CA 92253 Printed: Monday, May 11, 2015 8:41:07 AM 1 of 2 CR?WlYSTEMS ?I Printed: Monday, May 11, 2015 8:41:07 AM 2 of 2 0r , SYSTEMS CLTD .: DESCRIPTIONBY ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK METHOD PAID BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: GAS SYSTEM, 1-4 101-0000-42401 0 $12.09 $0.00 OUTLETS GAS SYSTEM, 1-4 101-0000-42600 0 $24.17 $0.00 OUTLETS PC Total Paid for PLUMBING FEES: $36.26 $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 tOfALS: $317.17 00 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SC HEDULED COMPLETED RESULT REMARKS. NOTES DATE DATE FINAL" BLD PARENT PROJECTS RETURNED REVIEWS STATUS REMARKS REVIEW TYPE REVIEWER SENT DATE DUE DATE NOTES DATE . KIRK 5/8/2015 5/8/2015 NON-STRUCTURAL KIRKLAND Printed: Monday, May 11, 2015 8:41:07 AM 2 of 2 0r , SYSTEMS l' :N4lti F`H%OF;'M�9 MCRAE POOLS & SPAS . 79 105 DESERT STREAM DRIVE Invoice Date: 5/11/2015 City of La Quinta 78-495 Calle Tampico La Quinta,CA 92253 Record # Record Type Fee Group INVOICE # INV -213 Date Due: 6/10/2015 Fee Description Quantity Amount LIC -0004935 CONTRACTOR C, ANNUALLY 0 $50.00 PENALTY 0 $25.00 SB -1186 STATE FEE 0 $1.00 $76.00 Invoice Total: $76.00 Please send your payment to this address: Printed: Monday, May 11, 2015 11:18 AM 1 of 1 SYS TEM S To: GOVERNMENT OUTREACH 2943 VICTORIA MEADOW CT PLEASANTON CA 94566 BUSINESS LICENSE NO. 0099779 78-495 Calle Tampico La Quinta, California 92253 BUSINESS LICENSE DIVISION (760)777-7000 FAX (760) 777-7105 www.la-quinta.org To avoid incurring penalties (Ordinance 3.28.380), please return this invoice along with your check prior to your expiration date of: June 30, 2015 BUSINESS LICENSE RENEWAL Subject to the provisions of the La Quinta Municipal Code Section 3.28.390, persons with a fixed place of business within the City of La Quinta shall pay an annual business license fee based upon actual gross receipts for the past twelve months. Type of Business: Gross business receipts during last twelve (12) months: ** Penalty fee is 10% per month of Business License Fee:$ total business license fee **Penalty % $ TOTAL FEES: $ Name of Owner(s) or Officer(s) and Title(s): State Board of Equalization Tax I. D. #: Sellers Permit# PLEASE INDICATE ALL VEHICLE PLATE NUMBERS THAT WILL BE USED IN THE BUSINESS. . License Plate Number Permit Number (FINANCE USE ONLY) I HEREBY CERTIFY that all the information supplied by me is correct and any license required by the County, State of Federal Government have been issued to me and are in full force and effect. Signature(s): Title(s) Date: Thank You for doing business m the City of La Quintan Contact Information Updates or Corrections (Please print address, phone numbers). *On September 19, 2012 Governor Brown signed into law SB -1 186 which adds a state fee of $1 on any applicant for a local business license permit, or renewal. air► # . 0ty Of La .Q uinta ' Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 0011' Building Permit Application and Tracking Sheet Permit # Is-- Project Address: y F11i:F (� �' ' Owner's Name: tg- A. P. Number: Address: '7 q. 7v 9 N Legal Description: City, ST, Zip: LA QL1 IAf7—In' Contractor: S S Telephone: Project Description: Address: STPEAMQ City, ST, Zip: L �S� , Telephone: %0.77 Y- 63 q2 State Lic. # : Q City Lic. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: 3:i`fs; v = w'`` P 1.:.a:. w:>r':: ;...'..lx.. ';•' •::v�: 'vh\:'i}iiit::vS�iv State Lic. #: ^'' :.i. Lv:iFl>vn`eC!:N{:1.titi(•?i:i<:fS<; �:.i:. i.{: �Y:: Name of Contact Person:Chi 6' Construction Type: Occupancy: Project a circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: — 7% y— 3 y 3 Estimated Value of Project: r' APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Coles. Reviewed, ready for corrections Plan Check Deposit Truss Coles. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 20° Review, ready for correct; onsfissue 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 correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees ur i ' CITY OF LA GUINTA SUB- ONTRACTOR.LIST PERMIT NUMBER-P,, NER - - . - - BUILDER 7_77912 :106 ADDRESS %c1 �`% 9 -�N�E work Only appearing on this list or their employees are authorized This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. persons list be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppag e of of work and/or the voidance on this job. Any changes to this must - each applicable trade, ore 0 f building permit. F pp 9 below must be completed. by applicant. 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