BPOL2015-000978-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4t!� 4 4 Q"
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Application Number:
BPOL2015-0009
Owner:
Property Address:
81655 MACBETH ST
IOTA GRIFFIN
APN:
767800064
4675 MACARTHUR CT NO 1550
Application Description:
POOL, SPA, BBQ, AND FIRE PIT AT REAR YARD
NEWPORT BEACH, CA 0
Property Zoning:
Application Valuation:
$35,000.00
Q�
D �— a
Applicant:
Contractor:
TESERRA
PO BOX 1280
JAN 0 9 2015
TESERRA
PO BOX 1280
COACHELLA, CA 92236
OF LA
COACHELLA, CA 92236
COMMUNITYpEyE1OPPMCITY
El DEPARTMENT
(760)398-9222
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. C27, C10, C29. C53 - License No.: 656128
_I--�
Date: 7 a1. S Contractor: 1 Eje_leJ'4r
I7
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 of county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, al<o 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 -he 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 ) 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 Name:
Lender's Address:
Date: 1/9/2015
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: S Applicant;/�%A/A!�f a/2N7
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.
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: _1y� Signature (Applicant or Agent):A%4/Srf 1 /7.i/.e&7z
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
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
'
Total Paid for PLUMBING FEES: $36.26 $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: POOL, SPA, BBQ AND FIRE PIT AT REAR YARD
Type: POOL Subtype: Status: APPROVED
Applied: 1/8/2015 SKH
Approved: 1/8/2015 JFU
Parcel No: 767800064 Site Address: 81655 MACBETH ST LA QUINTA,CA 92253
Subdivision: TR 32879 Block: Lot: 139
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $35,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
ACTION DATE
Details: POOL, SPA, BBQ, AND FIRE PIT AT REAR YARD [DOUGLAS FERRELL ENGINEERING] THIS PERMIT DOES NOT INCLUDE EQUIPMENT
ENCLOSURE. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE.
Printed: Friday, January 09, 2015 11:29:08 AM 1 of 3 CN?
SYSTEMS
CHRONOLOGY
CHRONOLOGY TYPE
STAFF NAME
ACTION DATE
COMPLETION DATE
NOTES
PLAN CHECK SUBMITTAL
RECEIVED
STEPHANIE KHATAMI
1/8/2015
1/8/2015
TELEPHONE CALL
JAKE FUSON
1/8/2015
1/8/2015
NOTIFIED MOISES W/ TESERRA PLANS WERE APPROVED AND
PERMIT READY TO ISSUE.
CONDITIONS
CONTACTS
- NAME TYPE
_
NAME
ADDRESS!CIT`:
STATE
TIP '
PHONE.
FAX
EMAIL
APPLICANT
TESERRA
PO BOX 1280
COACHELLA
CA
92236
CONTRACTOR
TESERRA
PO BOX 1280
COACHELLA
CA
92236
OWNER
IOTA GRIFFIN
4675 MACARTHUR CT
NO 1550
NEWPORT
BEACH
CA
0
Printed: Friday, January 09, 2015 11:29:08 AM 1 of 3 CN?
SYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
FINANCIAL
INFORMATION
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 forELECTRICAL:
$48.34
$0.00
GAS SYSTEM, 1-4
101-0000-42401
0
$12.09
$0.00
OUTLETS
GAS SYSTEM, 1-4
101-0000-42600
0
$24.17
$0.00
OUTLETS PC
Total Paid for PLUMBING FEES:
$36.26
$0.00
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
$0.00
SWIMMING POOL/SPA
101-0000-426000
$98.62
$0.00
PC
Total Paid for POOL/ SPA:
$279.91
$0.00
TOTALS:00
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES - -
FINAL**
Printed: Friday, January 09, 2015 11:29:08 AM 2 of 3
RWSYSTEMS
BOND INFORMATION
Printed: Friday, January 09, 2015 11:29:08 AM 3 of 3
RWSYSTEMS
Bin # �
1
!
Permit #
Project Address: 6EY j
A. P. Number:
Legal Description:
Contractor:
71—Ff
Address: Ek 1 -66
City, ST, Zip:
(..> I- C j-{•tr U- I
Telephone: -? & a 30)
State Lic. #: 6, 6 Z
Arch., Engr., Designer: t
i
Address: '
City., ST, Zip: !
Telephone: I
State Lic. #: !
Name of Contact Person:
Telephone #,of Contact Person: ;
# Submittal Req'd
Plan Sets
Structural Calcs.
Truss Cales.
Title 24 Calcs.
Flood plain plan `
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval I
Pub. Wks. Appr
Qty ®f La Quint'a
Building U Safety Division,
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Applicati®n and Tracking Sheet
Address: 16, -� f?H
City, ST, Zip:
Telephone:
Project Description: O0
°1-Z..23 &P ,e E _ P/ T .
City Lic. #;
ZZ573•
's�,af£
Construction Type'
Occupancy
• %f' 3� 4'iyy'
V��t�?W •`4 4
Project type(circle one):(fe-,_q:�Add'n Alter Repair Demo
rI�1iYI/ EZ
-'5-0
- Sq. Ft.:
# Stories:
#Units:
y
Estimated Value of Project:
3S • O(J�
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd
Z RACICTIVG
PERMIT (FEES
Plan Check submitted
J S
Item
Amount
Reviewed, ready for eesreetiers ISSvE
a
Plan Check Deposit
Called Contact Person
�S
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2°" Review, ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I
Plans resubmitted
Grading
Reylew, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.I.P.P,
Total Permit Fees