BPOL2017-0012LICENSED 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.: 614611
Date:�� ' 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
Lender's Add
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 rk for which this permit is issued.
1 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: WESCO INSURANCE COMPANY Policy Number: WWC3081632
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: — Applican .
WARNING: FAILURE TO SECURE WORKERS' CO PENSATION 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
MPORTANT: 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
*equest and for whose benefit work is performed under or pursuant to any permit
ssued as a result of this application , the owner, and the applicant, each agrees to, and
;hall 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
'ollowing issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
iot commenced within 180 days from date of issuance of such permit, or cessation of
Nork for 180 days will subject permit to cancellation.
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
:onstruction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
)ate Signature (Applicant or Agen
:
78-495 CALLE TAMPICO
4
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
DESIGN &DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number: BPOL2017-0012
0
Z
Owner:
Property Address: 53805 VIA BELLAGIO
PETER BORDEN
z'
APN: 777170013
1609 VIA LAZOo
CZ –n
Application Description: BORDEN / POOL, SPA, WATERFALL, FIRE PIT
PLS VRDS EST, CA 0
r M
Property
Zoning:
Application Valuation: $75,000.00
r—O
CD
•
� W
Applicant:
Contractor:
1 c No
MC INTYRE POOLS & SPAS INC
MC INTYRE POOLS & SPAS IC D
83-69S AVENUE 45
83-695 AVENUE 45
INDIO, CA 92201
INDIO, CA 92201
m
z
(760)342-3612
—�
Llc. No.: 614611
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.: 614611
Date:�� ' 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
Lender's Add
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 rk for which this permit is issued.
1 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: WESCO INSURANCE COMPANY Policy Number: WWC3081632
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: — Applican .
WARNING: FAILURE TO SECURE WORKERS' CO PENSATION 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
MPORTANT: 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
*equest and for whose benefit work is performed under or pursuant to any permit
ssued as a result of this application , the owner, and the applicant, each agrees to, and
;hall 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
'ollowing issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
iot commenced within 180 days from date of issuance of such permit, or cessation of
Nork for 180 days will subject permit to cancellation.
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
:onstruction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
)ate Signature (Applicant or Agen
Date: 2/13/2017
(760)342-3612
Llc. No.: 614611
Detail: POOL, SPA, AND FIRE PIT AT REAR YARD, WITH A WATER FEATURE AT FRONT COURTYARD [DENISE POELTLER ENGINEERING] THIS PERMIT DOES NOT
INCLUDE EQUIPMENT ENCLOSURE. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2016 CALIFORNIA BUILDING CODE.
Application Number:
BPOL2017-0012
Owner:
Property'Address:
53805 VIA BELLAGIO
PETER BORDEN
APN:
777170013
1609 VIA LAZO
Application Description:
BORDEN / POOL, SPA, WATERFALL, FIRE PIT
PLS VRDS EST, CA.0
Property Zoning:
Application Valuation:
$75,000.00
Applicant:
Contractor:
MC INTYRE POOLS & SPAS INC
MC INTYRE POOLS & SPAS INC
83-695 AVENUE 45
83-695 AVENUE 45
INDIO, CA 92201
INDIO, CA 92201
Date: 2/13/2017
(760)342-3612
Llc. No.: 614611
Detail: POOL, SPA, AND FIRE PIT AT REAR YARD, WITH A WATER FEATURE AT FRONT COURTYARD [DENISE POELTLER ENGINEERING] THIS PERMIT DOES NOT
INCLUDE EQUIPMENT ENCLOSURE. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2016 CALIFORNIA BUILDING CODE.
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $3.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: 53.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
CITY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
CITY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$25.33
Total Paid for PLUMBING FEES: $38.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DETACHED SPA/WATER FEATURE/OTHER
101-0000-42404
0
$190.00
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: $483.36
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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CIN OF LA QUINTA
BUILDING 8 SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
on l°
-
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On.
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SEE SHEET L-5 FOR CONSTRUCTION DETAILS 5c_ALE: 1/8" : r-0"
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BUILDING 8 SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
on l°
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SEE SHEET L-5 FOR CONSTRUCTION DETAILS 5c_ALE: 1/8" : r-0"
Bin#
Submittal Req'd
city Of La Qurnta.
PERMIT FEES
Building st Safety Division
Plan Sets
Plan Check submitted
P.O. Box ISO4, 78495 Calle Tampico
'Permit #
La Quinta, CA 92253 - (760) 777-7012
91P OL.2,017 00 12
Building Permit Application and `Tracking Sheet
Project Address: S'?2, �� b(,� a (�
Owner's Name: �JO�
A. P. Number. S
Called Contact Person
Address: � 3 — i'� /JC
Legal Description:
I.Tide
City, ST, Zip:
Contractor: C—Tv he S
S
Telephone:
Address: — 6c? S
Flood plain plan
Project Description:
City, ST,.Zip:�Jto C�
� 020
eve i
Telephone: 760 — . H �3(j X
Znd Review, ready for correctionslissye
Electrical
State tic. # : C 53 — I I City Lic: #; I
�S
Arch., Engr., Designer. .
Called Contact Person
Plumbing .RE
Address:
Grant Deed
City.; ST, Zip:
AWN
S.M.L
V
Telephone:
H.O.A. Approval
Construction Type: Occupancy:
State Lk. #:
2017
, a: Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
a
Sq. Ft.: # Stories: #.Units:
Telephone # of Contact Person: 0 —
S
Estimated Value of Project: golf
'Called Contact Person
AXP.P. is a ice: 4� �ilb,v j11
Pub. Wks. Appr `
APPLICANT: DO NOT WRITE 13ELOW THIS LINE
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Submittal Req'd
Rec'•d TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.,
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs. '
Called Contact Person
Plait Check Balance.
I.Tide
24 Cales.
Plaus .picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
Znd Review, ready for correctionslissye
Electrical
Subcontactor List
Called Contact Person
Plumbing .RE
Grant Deed
Plans.picked up
AWN
S.M.L
V
H.O.A. Approval
Plans resubmitted
FE
Grading
2017
IN-HOUSE:
''' Reyiew, ready for correctionstiissue
Developer Imps Wei
'11 KITA
Planning Approval •
'Called Contact Person
AXP.P. is a ice: 4� �ilb,v j11
Pub. Wks. Appr `
Date of permit issue
School Fees
Total Permit Fees