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 ..-!•.:. ;�,. .,.;;�;.
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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 ..-!•.:. ;�,. .,.;;�;.
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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
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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