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BPOL2016-0175„c. 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 c&ht 4 4v Qumz DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT r VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: - BPOL2016-0175 Owner: Property Address: 80234 CHAMPIONS WY Z r—" TIBB APN: 775220021 t D 80234 CHAMPIONS WY Application Description: TIDD / POOL AND EQUIPMENT NOV 2 2 2016 LA QUINTA, CA 92253 Property Zoning: Application Valuation: $20,000.00 CITY OF LA QUINTA Applicant: DESIGN AND DEVELOPMENT DEPARTMENT contractor: TESERRA TESERRA P 0 BOX 1280 P 0 BOX 1280 COACHELLA, CA 92236 f COACHELLA, CA 92236 (760)389-9222 Llc. No.: 656128 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: C-8, C10, C29, C53, C27, D12 License No.: 656128 Dc ate// ZZ fContractor:77Ef �2 e)dc 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 provingthat he or she did not build or improve for the purpose of sale.). (1 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 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: f Date: 11/22/2016 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: STARSTONE NATIONAL INSURANCE COMPANY 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: 11 2Z 11l0 -Applicant: ZA/fl f'EI ��nti►267z 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 perty for inspection purposes. Date: // 2 pr Z % Signature (Applicant or Agent):4U11-er ��/:�tz Date: 11/22/2016 Application Number: BPOL2016-0175 Owner: Property Address: 80234 CHAMPIONS WY TIBB APN: 775220021 80234 CHAMPIONS WY Application Description: TIDD / POOL AND EQUIPMENT WALL LA QUINTA, CA 92253 Property Zoning: Application Valuation: $20,000.00 Applicant: Contractor: TESERRA TESERRA P 0 BOX 1280 P 0 BOX 1280 COACHELLA, CA 92236 COACHELLA, CA 92236 (760)389-9222 ------------------------------------------- --------------------------------------------------- Llc. No.: 656128 Detail: POOL AT REAR YARD AND 14 LF OF CITY STANDARD EQUIPMENT WALL AT SIDE YARD [DENISE POELTLER ENGINEERING) ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE. FINANCIAL .• {. DESCRIPTION ACCOUNT QTY AMOUNT WALL/FENCE - FIRST 100 LF 101-0000-42404 0 $50.67 DESCRIPTION ACCOUNT QTY AMOUNT WALL/FENCE - FIRST 100 LF PC 101-0000-42600 0 $63.33 Total Paid for BLOCK WALL: $114.00 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 SWIMMING POOL/SPA 101-0000-42404 0 $190.00 DESCRIPTION ACCOUNT QTY AMOUNT SWIMMING POOL/SPA PC 101-0000-42600 01 $103.36 Total Paid for POOL / SPA: $293.36 Bin # Qty Of La QuIonia NOV 1.7 2016 Building 8L Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico CITY OF LA DUINTA La Quinta, CA 92253 - (760) 777-7012 COMMUNITY DIMLOPME Building Permit Application and Tracking Sheet Project Address: 002—'341 Owner's Name: �D A. P. Number: . Address: DZ 3 P/DNS GLi►- Legal Description: _ City, ST, Zip: ZZS 3 Contractor: Telephone: Address:. 51p l pv I4vt= S-LI Project Description: • v yr e City, ST, Zip: Telephone: 7( D 8 2 -2- State State Lie. # : City Lie. #; Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lie. #: ;:yea% %jr. X'y�'Cr.ao•^.••f+.- �: f-•af+ f,r,• a>: c: ;:a: t ' Construction Type: Occupancy: Project type (circle one) New Add'n Alter Repair Demo Name of Contact Person: D/� r✓ S /2p� ' 2 -Sq. Ft.: /p # Stories: #Units: Telephone #,of Contact Person: -7 2S0 - / cJ'••f / Estimated Value of Project: '2_z>, o po- APPLICANT: DO NOT WRITE 13ELOW THIS LINE 9Submittal Req'd Recd TRACKING PERMIT &EES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cale-S. Called Contact Person Plan Check Balance. Title 24 Cales. Plans picked up Construction Floodplain 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. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 'r° Reyiew, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. . Pub. Wks. Appr Date of Dermit Issue Sc11061 Fees Total Permit Fees