BPOL2015-0126j 78-495 CALLE TAMPICO — VOICE (760) 777-7125
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LA QUINTA, CALIFORNIA 92253 DUDD FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/17/2015
Application Number: BPOL2015-0126
Owner:
Property Address: 51420 CALLE JACUMBA
MARK GREEN
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APN: 770166024
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Application Description: JACKSON / POOL SPA AND BBQ
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Property Zoning:
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Application Valuation: $30,000.00
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Applicant:
Contractor:
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GARY & SON'S LEAK DETECTORS IN
GARY & SON'S LEAK DETE
IN
67621 CACTUS APPLE DRIVE
67621 CACTUS APPLE DRI E
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DESERT HOT SPRINGS, CA 92241
DESERT HOT SPRINGS, CA 9224��--
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(760)251-8945
Llc. No.: 866518
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under pr visions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business an Professions Code,,.
and my License is in full force and effect.
License Class: C53 License No.: 866518A A
(Date: k0T Contract/
OWNER -BUILDER DECLARfrION
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 ) 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. Q.
Lender's
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: _
`�J 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: Q I:1::�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.
_. 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 stat aws relatingl building
ccnstruction, and hereby authorize representatives of this city�o enter uporf'the above.
mentioned property for inspection purposes. 1
Date: 1 /)�1 1 STI 1 Signature (Applicant or Agent):
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
QTY AMOUNT
PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306
0 $2.00
$0.00
PAID BY METHOD
RECEIPT # _
CHECK # CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $2.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT # -
CHECK #
CLTD BY
Total Paid for ELECTRICAL: $48.34 $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:00
Description: JACKSON / POOL SPA AND BBQ
Type: POOL Subtype: Status: UNDER REVIEW
Applied: 6/17/2015 SKH
Approved:
Parcel No: 770166024 Site Address: 51420 CALLE JACUMBA LA QUINTA,CA 92253
Subdivision: DESERT CLUB TR UNIT 2 Block: 2 Lot: 16
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $30,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: POOL, SPA, AND BBQ WITH [3/4 INCH GAS PIPING POLY. IN 1 INCH CONDUIT ELECTRICAL] THIS PERMIT DOES NOT INCLUDE
WATER/SEWER AT BBQ, WALL OR FIRE PIT. EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH MANUFACTURER
SPECIFICATIONS. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING
CODE.
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
GARY & SON'S LEAK DETECTORS IN
67621 CACTUS APPLE
DRIVE
DESERT HOT
SPRINGS
CA
92241
CONTRACTOR
GARY & SON'S LEAK DETECTORS IN
67621 CACTUS APPLE
DRIVE
DESERT HOT
SPRINGS
CA
92241
OWNER
MARK GREEN
Printed: Wednesday, June 17, 2015 3:41:03 PM 1 of 2 ffMJF
sys'nms
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
BSAS SB1473 FEE
101-0000-20306
0
$2.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $2,00 $0.00
BSA:
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
Total Paid for ELECTRICAL: $48.34 $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
TOTALS:• •0
Printed: Wednesday, June 17, 2015 3:41:03 PM 2 of 2 cI
srsreens
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
FINAL" BLD
Printed: Wednesday, June 17, 2015 3:41:03 PM 2 of 2 cI
srsreens
M
Bin #
City of La Quinta
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and Tracking Sheet
Permit #
13VU-9-01 S-012
Project Address: rOwner's
Vvlbc,
Name:IA
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor. 41,
Telephone:
Address: _(tile
Project Description: U �'
City, ST, Zip: i
Q
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Telephone:
P o e.•
State Lic. # : e3 ('0 5—
City Lie. #.-.
Arch., Engr., Designer:
Address:'
City., ST, Zip:
Telephone:
>':<'.«
i s«
Co nstructi on Type: Occupancy:
P Occu Y•
t a Li
Sto c #:
Project ha (circle one • New Add'n Ater Repair Demo
Name of Contact Person•
Sq. Ft.:#Stories:
#Units:
Telephone # of Contact Person:3
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
H
Submittal
Req'd
Ree'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
tad Review, ready for corrections/issue
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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CITY. OF LA QUINTA LIST
JOB ADDRESS — d-0
61LAyylk
.SUR-CONTRACTOR
PERMIT. NUMBER'F7'�''DL- Lfl:�WNER ��o 'l BUILDER
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 em loyees 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 competed by applicant. "On File" is not an acceptable response.
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.....Trade./..Class canon .................
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License Number
Exp. Date
Carrier
Policy Number
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Phone:
60 894
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67-621 Cactu!5 Apple Pr
Fax:
(760) 251-6665
J. mancilla
Peoigned
51420 Calle Jacumba
PH5 CA 92241
E -Mail:
jairriepiaounafaiiopooio.com
5/25/2015
for:
La Quinta C A 9 2 2 5351