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BPOL2015-0085LICENSED 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: C53 License No.: 833313 W. / fDat�� (� 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 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 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: 7 � 1 �, Applicant: JL 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 property for inspection purposes. Date: 5" I Signature (Applicant or Agent): C` a& QUM& VOICE (760) 777-7125 78-495 CALLE TAMPICO 0 D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 5/5/2015 Application Number: BPOL2015-0085 Owner: Property Address: 53365 HUMBOLDT BLVD MC GRAW - BERQUIST APN: 767700014 53365 HUMBOLDT BLVD L Application Description: MC GRAW - BERQUIST RESIDENCE/POOL SPA LA QUINTA, CA 92253 z Property Zoning: Application Valuation: $45,000.00 I a w Applicant: =z Contractor: A 1 g g LU LINDLY'S POOLS OF CALIFORNIA I g LINDLY'S POOLS OF CALIFORNIA I I O U. LU 30755 DESERT PALM DRIVE 30755 DESERT PALM DRIVE o q U THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276 s Z (760)343-0600 C) Llc. No.: 833313 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: C53 License No.: 833313 W. / fDat�� (� 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 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 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: 7 � 1 �, Applicant: JL 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 property for inspection purposes. Date: 5" I Signature (Applicant or Agent): FINANCIAL INFORMATION DESCRIPTION ACCOUNT CITY 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 CITY AMOUNT PAID PAID DATE SWIMMING POOL/SPA 101-0000-42404 0 $181.29 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT. CITY AMOUNT PAID PAID DATE SWIMMING POOL/SPA PC 101-0000-42600 0 $98.62 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER FEATURE ONLY 101-0000-42404 0 $181.29 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE WATER FEATURE ONLY PC 101-0000-42600 0 $98.62 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forPOOL /SPA. $559.82 $0.00 TOTALS:00 F,. Description: MC GRAW - BERQUIST RESIDENCE/POOL SPA Type: POOL Subtype: Status: APPROVED Applied: 5/4/2015 MFA Approved: 5/4/2015 KKI Parcel No: 767700014 Site Address: 53365 HUMBOLDT BLVD LA QUINTA,CA 92253 Subdivision: TR 33076-2 Block: Lot: 62 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $45,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: POOL, SPA, AND WATER FEATURE. THIS PERMIT DOES NOT INCLUDE ELECTRICAL BBQ, FIRE PIT OR WALL. EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH MANUFACTURER SPECIFICATIONS. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE - PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE. Printed: Tuesday, May 05, 2015 8:52:20 AM FINANCIAL INFORMATION 1of2 CRW YSTEMS ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES NOTE PHILIP JUAREZ 5/4/2015 sent back to philip CONDITIONS NAME TYPE NAME ADDRESSICITY STATE ZIP PHONE FAX EMAIL APPLICANT LINDLY'S POOLS OF CALIFORNIA 1 30755 DESERT PALM THOUSAND CA '92276 DRIVE PALMS CONTRACTOR LINDLY'S POOLS OF CALIFORNIA 1 30755 DESERT PALM THOUSAND CA 92276 DRIVE PALMS OWNER MC GRAW - BERQUIST 53365 HUMBOLDT LA QUINTA CA [ 92253 BLVD I . Printed: Tuesday, May 05, 2015 8:52:20 AM FINANCIAL INFORMATION 1of2 CRW YSTEMS �+- Permit 11D, Is PERMIT NUMBER 9RDR 15-0085 City Of La Quinta a���,.��z�".�:� _. "����:; �. � ✓j �:;�., PARENT PROJEC S� :�.:,.�{ �' - ,� �.-.s.�.��. _..,..F:..- ... "� L.s_� :.. . � ,ext � � .. ... ._:.._,ff•�..> . � - �.: �"t-r ..-!•.:. ;�,. .,.;;�;. 1 ' y :a r> � � Printed: Tuesday, May 05, 2015 8:52:20 AM 2 of 2 CIFVl./ srsreMs CLT D DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $2.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $2,00 $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 WATER FEATURE ONLY 101-0000-42404 0 $181.29 $0.00 WATER FEATURE ONLY 101-0000-42600 0 $98.62 $0.00 PC Total Paid for POOL/ SPA: $559.82 $0.00 -2 S. +r'.:'Y. • 7.:i:' .45$ 1 1 1 •'-t..eti7• . �' - C.. 4 '?t e. r,+f¢ . zala h'yf x+ ^;. a���,.��z�".�:� _. "����:; �. � ✓j �:;�., PARENT PROJEC S� :�.:,.�{ �' - ,� �.-.s.�.��. _..,..F:..- ... "� L.s_� :.. . � ,ext � � .. ... ._:.._,ff•�..> . � - �.: �"t-r ..-!•.:. ;�,. .,.;;�;. 1 ' y :a r> � � Printed: Tuesday, May 05, 2015 8:52:20 AM 2 of 2 CIFVl./ srsreMs # . - ,ty. of La Qulnta Bwkbg $t Safety DMdon P.O. Box 1504,78-495 Calk Tampico 14.Quh94 CA 92253 -:(760) 777-7012 Building Permit Application and Tracking Sheet Permit # V� I'mjecc Address: U L�O7 bV Owner's Name:. M ew d �3� �, ST, A. P. Number. Addrew: 52 —'3t-6. RV LO T . 8V) L&lW Legal Description: contractor. Contractor.-7�1 N p`,`f S �tbi.S dY (A 1�CJ City, ST, Zip: LA ()I A(J."A CA 2,ks -5 Telephone: Project Description: Address: O� ��S p�s��f p 01& City, ST, Zip: T�Jb V S Oc rio P^ vn (A Telephone: %0-s -0600 State Lie. #: City Lie. #; `W�U Arch- Bag., Designer Address: City., ST, Zip: Telephone: State Lie.#= Type:. Occupancy: circle one): New Add'n Ahar Repair Demo #Stories #Units EF Name of Contact Person: Q S G 6 � � l L, Z Telephone # of Contact Person: �� Z. ��� 7i lue of Project: tl!L OJJ z= APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACMG PERM r FM - Plan Sets Plan Cheek submitted • item Amount Structural Calm Reviewed, ready for corrections Plan Cheap Deposit. . Truss Cates. Called Contact Person Plan Check Balance Mae 24 Cala. Diana picked up Construction Flood plain plan Plans resubmitted.. Mecharileal Giading pl" Za° Review, ready for corrections/issue Electrical Subeostactor List Called Contact Person Plumbing Grant Deed Plana pidmd up S.M,I, H.O.A. Approval Plans resubmitted Grading IN ROUSE:- 'ed Review, ready for torreetiooarmot Developer Impact Fee Planning Approval Called Contact Person A.i.P.P. Pub. Wks. Appr - Date of permit issue School Fees Total Permit Fees PERIMETER WALLS BY OTHERS - ! XI ¢ POOL EQUIPMENT WATER FEATURE EQUIPMENT > v� EQUIPMENT WALL ENCLOSURE BY OTHER EQUIPMENT LL ENCLOSURE BY OTH S v 1 ti RESIDENCE PA DOOR ALARM PER CODE DOOR ALARM PER CODE POOL DECK BY OTHERS - .--a -fig WATER FEATURE - J POOL J,6" roo = FENCE WALL BY OTHERS -V l PA ( POOL DECK BY OTHERS PA r SUNKEN BAR BY OTHERS ZERO EDGE SPA BLOCK WALL BY OTHERS iOq� wq)y0 YO�FRs PA CONSTRUCTION NOTES: POOL 14'X66' DEPTH: 3'6"-6'-3-6" AREA: 940 SQ. FT. PER.: 176 LN. FT. POOL TO HAVE 8 DECK JETS SPA 5' X 9' RAISED + 18" AREA: 45 SQ. FT. PER.: 28 LN. FT. SPA TO HAVE 8 JETS TANNING SHELF: 6'X 12' -9" OF WATER WATER LINE TILE TO BE PROVIDED BY HOMEOWNER. INSTALLED BY LINDLYS. POOL AND SPA TO BE FINISH IN PEBBLE POOL DECK BY OTHERS. WATER FEATURE 3'X49' 18" DEEP AREA: 150 SQ. FT. PER.: 105 LN FT FINISH TO MATCH POOL AND SPA EQUIPMENT (PENT -AIR SYSTEMS): (1) PENT -AIR VARIABLE SPEED PUMP (1) 420 SQ. FT. CLEAN AND CLEAR FILTER (1) 400K BTU MASTER TEMP HEATER (1) 2HP WHISPERFLO PUMP—DECK JETS (1) 1HP WHISPERFLO PUMP—WATER FEATURE (1) 50 SO. FT. CLEAN AND CLEAR CARTRIDGE FILTER (1) IC40 EASY TOUCH 8 FUNCTION SALT SYSTEM WIRELESS (4) 543 WHITE LED POOL LIGHTS (1) 513 WHITE LED SPA LIGHT (5) 5G WHITE LED WATER FEATURE LIGHTS I OOORq�� "1 RMP�COOR O,� m ti GUEST C 110.4 Em SJ . CggTPORT PA FENCE WALL BY OTHERS { oq�G f w�CSOYO I �fRS f PA i t i 30755 DESERT PALM DRIVE PROJECT#:2057 THOUSAND PALMS CA 92276 DRAWN BY: JOSE GONZAlE2 LIC. # 833313 WWW.LINDLYSPOOLSCA.COM r DATE: APRIL':15, 2015 I CITY )F QUIfVTr�'. BUILDING & SAFETY DEPT. APP OVER FOR CON TRUCTION )ATE 6 8Y PROJECT NAME: T MCGRAW-BERGQUIST A 01 53365 HUMBOLDT BOULEVARD SCALE: 118" =1 FT LA QUINTA CA