BPOL2016-0103L Y
r`
VOICE (760) 777-7125
78-495 CALLE TAMPICO C& A U Qum.4
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
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: License No.: _
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).:
f 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 notintended 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
h e did,not build or improve for the purpose of.sale.).
I, as owner of the property, am exclusively contracting with licensed contractors
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 contractors) licensed pursuant to
th ' ontractors' State License Law.).
{� s am exempt under Sec. B.&P. o�this�ason
Date '7
i
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. 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 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:
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 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 io 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 ter upon the
above-mentioned property for inspection purposes. ��.
Date: 7/15/2016
Application Number:
BPOL2016-0103
Owner:
Property Address:
79185 SHADOW TR
RICHARD WALLACE
APN:
600400006
79185 SHADOW TR
Application Description:
WALLACE RESIDENCE/ POOL
LA QUINTA, CA 92253
ProPerty Zoning:.
Application Valuation:
$22,000.00
Applicant:
Contractor. D
RICHARD WALLACE
OWNER / BUILDER
79185 SHADOW TR
CA QUINTA, CA 92253
u I JUL
-2016
CITY OF LA OUINTp
COMMUNITY DEVELOPMENT DEPARTiOENT
Llc. No.:
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: License No.: _
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).:
f 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 notintended 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
h e did,not build or improve for the purpose of.sale.).
I, as owner of the property, am exclusively contracting with licensed contractors
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 contractors) licensed pursuant to
th ' ontractors' State License Law.).
{� s am exempt under Sec. B.&P. o�this�ason
Date '7
i
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. 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 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:
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 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 io 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 ter upon the
above-mentioned property for inspection purposes. ��.
JINANCIAL INFORMATION,
.DESCRIPTION ,, .5 ACCOUNT a
I.QTY AMOUNTIy}
' PAID
PAID.DATEx
BSAS SB1473 FEE 101-0000-20306
0 $1.00
$0.00
.rxPAID:BY,�.'a�`.'`#�METHOD c
;-RECEIPT:#..,,
�CLTDBY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:' $1.00
$0.00-
�* r <'DESCRIP_TION .., a
- �„
f'' � �k� UACCOUNT t:
, <
.QTY
Y,'AMOUNT 'fII
��
PAIDkPAIDYDATE
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
$0.00
BY a,
METHOD'
i k RECEIPT #"1
CHECK #
CLTD BY
r s,DESCRIP.TIONR"�ACCOUNT�x=
" � !
QTY
ISGAMOUNT �
�ti�,# � PAID
IPAID;DATE
SWIMMING POOL/SPA PC
101-0000-42600
0
$98.62
` $0.00
PAID BYt'.: f
# * rr ;METH DF.J
RECEIPT # s."
„. - � s
CHECK #
CLTD BY-:
.Total Paid for POOL/ SPA: $279.91
TOTALS::0
$0.00.
S
Description: WALLACE RESIDENCE / POOL
Type: POOL
Subtype: Status: APPROVED
Applied: 7/13/2016 MFA
Approved: 7/14/2016.UCL
Parcel No: 600400006 Site Address: 79185 SHADOW TR LA QUINTA,CA 92253
Subdivision: TR 31310
Block: Lot: 6
Issued:
Lot Scl Ft: 0
Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $22,000.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0.
Details: POOL AND SPA ONLY.
JEFFREY COLLINS ENGINEERING. ENGINEERING. EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH
MANUFACTURER SPECIFICATIONS. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. PER 2013
CALIFORNIA BUILDING CODE.
';. �-- _ --
Applied to Approved:.'
Printed: Friday, July 15, 2016 7:56:34 AM 1 of 2 - CPWIYSTEAYtS
•
FINANCIAL
••
DESCRIPTION " NT
ACCOUCITY 'AMOUNT
PAID
x;,: CLT D
PAID DATE RECELPT# CHECrt# ;. METk1OD PAID BY y- �`'
BY.
BSAS SB1473 FEE 101-0000-20306 0 $1.00
$0.00
-
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
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::• iii
Bin ##
lJ
D�
City of La Quin to ,
Building ar Safety Division
• 78-495 Calle Tampico -
La Quinta, CA 92253 (760) 777-7012
'Building_Pernjii Application and Tracking Sheet
Permit #�/
V
Project Address: Ig
Owner's Name: C 1
A. P. Number: O O6 —100
Address: Jr -'h
-Legal Description:
City,'ST,'Zip:• 1,3/
Contractor: 4
Telephone: 7 o- o� l 3
Address:
Project Description: Poo
City, ST, Zip:
.
Telephone: •
State Lie. 4:
- ,
City Lie. N.-
;Arch.,
Arch.,Engr., Designer:Rnal_
'
Address:
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City., ST, Zip: /I) eA
7
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Telephone:
hone:
9TYP
Construction
Occupancy:7
a e
State teLi. #•
Project type (circle one). ew Add'n Alter Repair Demo
Name of Contact Person:
I
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value" of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
tl `
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
an Sets'
Plan Check submitted
Itemmount
zl
Structure ales. .
Reviewed, ready for corrections ,
r
Plan Check Deposit
011
Truss Calcs.
Called Contact Person
Plan Check Balan
Title 24 Calcs.
Plans picked up
Constructio ' "
Flood plain plan
Plans resubmittedMeeh
nical
Grading plan
2"" •ew,.ready for-corrections/issue
Electrical
Subcontactor List
Called Contac " son
ell
Plumbing
Grant Deed
Plans picked up / '
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^! Reyieleady foi• corrections/issueDeveloper
Impact Fee
Planning Approvalled
Contact Person
A.LP.
Pub. Wks. Appr
t
Date of permit issue+
School Fees,
Total Permit Fees
CITY OF LA QUINTA SIB-GONT ACTOR_ LIST -
JOB ADDRESS -7 .1819"- S4hf)-Ow T�-
PERMIT NUMBER06L.;Q11,1630WNER ALE -.BUILDER_ LAJ
This form shall be posted on the job with the Building
Inspection Card at all times in a conspicuous place. Only persons appearing..on this list or their employees are authorized to work
on'this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work .and/or the voidance. .
of building permit. For each applicable trade, -all information requested below must be compieted.by applicant. "On File" is not an acceptable response-.
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:::::..::.......Workers.Co.m ensa. ion:.....................................
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DATE: 6/ 10/ 1 6
SCALE: as noted
DRAWING NUMBER
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