BPAT2017-0019Q�i VOICE (760) 777-7125
78-495 CALLE TAMPICO D
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/27/2017
Application Number: BPAT2017-0019 Owner:
Property Address: 45095 SUMMERBROOK CT CT DALE FRAILEY
APN: 604413009 45095 SUMMERBROOK CT
Application Description: FRAILEY RESIDENCE / PATIO C1 is //\ \ ® LA QUINTA, CA 92253
Property Zoning:`,/]
Application Valuation: $2,000.00
Applicant: MAR28M,Contractor:
CRYSTAL BLUE POOLS AND PATIOS CRYSTAL BLUE POOLS AND PATIOS
31166 ORANGE AVENUE CITY OFLA QUINTA 31166 ORANGE AVENUE
NUEVO, CA 92567
DESIGN AND DEVELOPMENTDEPMTMEM' NUEVO, CA 92567
(951)906-2761
Llc. No.: 846843
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, B, C-8, C27 License No.: 846843
t
Date:% d? � i 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 Name:
Lender's
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 t work for which this.permit is issued.
f) 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: SOUTHERN INSURANCE COMPANY Policy Number: OWC1005100
_ 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 worker'
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:�b g% AplicantF
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAVtlFUL,
AND SHALL SUBJECT -AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP —10
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR ODDER
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 permii issued
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, arca
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 wor< is not
commenced within 180 days from date of issuance of such permit, or cessation'oc 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 theabove-
mentioned property for inspection purposes:
D e 7 C% 1 'Signature (Applicant orAgent):-
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS:0:
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, STD, OPEN
101-0000-42404
0
$101.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, STD, OPEN PC
101-0000-42600
0
$100.32
Total Paid for PATIO COVER/ COVERED PORCH / LATTICE: $202.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS:0:
Bin #
Permit 1/,,
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Project Address:
City of La Q ull i to
Building &r Safety Division
78-495 Calle Tampico
--_-.La.Quinta, CA 92253 (760) 777-701.2
Building Permit Application and Tracking Sheet
A. P. Number:
Address:
Legal Description:
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Contractor:
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State Lic. # :
City Lic.
Arch., Engr., Designer:
Address:
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Telephone:
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Occupancy:
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State Lic. . #
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Name of Contact Person:LA
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#Stories:
#Units:
Telephone # of Contact Person:
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Estimated Value of Project:
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APPLICANT: DO NOT WRITE BELOW THIS LINE
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Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Chcek Deposit
i
Truss Calcs.
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.
II.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
Review, ready for corrections/issuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks_ Appr
Date of permit issuc
School Fees,
Total Permit Fees
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