BPOL2016-0043� t 1
78495,,CALLE1-AMPIC0
LA QUINTA; CALIFORNIA 92253
Application Number'
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
TESERRA
P 0 BOX 1280
COACHELLA, CA 92236
Titr4lwQ"
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BPOL2016-0043
S3S25 HUMBOLDT BLVD
767700018
DISCOVERY BUILDERS / POOL AND SPA AT COURTYARD
$32,000.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed unde provisions of Chapter
9 {commencing with Section 7000) of Division 3 of the Busin nd Professions Code,
and my License is in full force and effect.
License Class: C-8, C10, C29, C53, C27. D12 Licens o.: 656128
J'
Date:/12 .1 .4 Contractor:
Ll .01 11
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
Owner:
DISCOVEItYrBFJua ftDf V f -1 wuiivFA
LA QUINTA, CO53525 LT BLVD LOPMEW DEPARTMENT
DEC d'a4:201612
Contractor:
TESERRA
P 0 BOX 1280
COACHELLA,CA 92236
(760)389-9222
Llc. No.: 656128
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 bec a subject to the
workers' compensation provisions of Section 3700 of the La r ode, I shall forthwith
comply with those provisions.
Date: az!U C 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 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 tpofiuilding
construction, and hereby authorize representatives of this city to enter u the
above-mentioned property for inspection purposes.
Date. Z /r: Signature (Applicant or Age
Date: 12/21/2016
Application.Alumher.. u,BP,D12016 0043
Owner:
Property Address: 53525 HUMBOLDT BLVD
DISCOVERY BUILDERS
APN: 767700018
53525 HUMBOLT BLVD
Application Description: DISCOVERY, BUILDERS / POOL AND SPA AT COURTYARD
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $32,000.00
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 AND SPA AT COURT YARD AND 30 LF GAS LINE [DOUGLAS R. FERRELL ENGINEERING) THIS PERMIT DOES NOT INCLUDE EQUIPMENT
ENCLOSURE, BBQ, OR FIRE PIT. EQUIPMENT SHALL BE INSTALLED PER MANUFACTURER SPECIFICATIONS. ALARMS AND BARRIERS REQUIRED TO BE
INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE.
°`.+ :, • "' '. <:.->',,L-DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT
QTY
AMOUNT '
BSAS SB1473 FEE
101-0000-20306
0
$2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SWIMMING POOL/SPA PC
101-0000-42600
0
$98.62
Total Paid for POOL / SPA: $279.91
Iain /f
Permit ,#
n
i'0 X1 11 �O' O
Project Address:S7- ZS
Qty of La Quinta
Building a Safety Division
. . 78-495 Calle Tampico
La Quinta, CA 92253- (760) 777-701,2
Building Permit Application and Tracking Sheet
U 7,30�� //� Owner's Name: l�
A. P_ Number:
Address: S3 S Z S C d7>
Legal Description:
City, ST, Zip: Qu ('Ji -
n7
Contractor:'
T eleP hone:
Address:ko /00 S
Project Description:
City_ ST, Zip: ��HCM2G1r
922,3 2
O
TeleP0
hone: b 4 9 Z Z Z
o
State Lie. # : / Z e
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction TYaneY
Pe: Occupancy:
:
a L ,.
t Lic.#
c. •
Project type (circle one • �Add'n Alter Repair. r Demo
Name of Contact Person: 0
MI ��
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 6 2,S 0 2,3 /2
Estimated Value of Project: Q O -C)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
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.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`0. Review, ready for corrcctionstissuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
I
Total Permit Fees