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BPOL2015-0140-18-495 CALLE TAMPICO j LA QUINTA, CALIFORNIA 92253 t , Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: TESERRA PO BOX 1280 COACHELLA, CA 92236 BPOL2015-0140 81735 MACBETH ST 767800068 GRIFFIN RANCH / BROOKS / PC a T4'it 4 4 Qulaz COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT $35,000.00 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 CIO—C29, C53 Lizense No.: 656128 Date:. / /S Contractor.` Fes t'1Z 17/4 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 -he 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 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/30/2015 Owner: IOTA GRIFFIN 4675 MACARTHUR CT NO 1550 NEWPORT BEACH, CA 0 Contractor: TESERRA PO BOX 1280 COACHELLA, CA 92236 (760)3,98-9222 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 Secticn 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 App:icant:��/%O/rf 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 ofthis 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 w 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. Dater / / J Signature (Applicant or Agent): ��olroFf J2,5F7__ DESCRIPTION `a FINANCIAL INFORMATION 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 for BUILDING STANDARDS ADMINISTRATION BSA: $2.00 $0.00 DESCRIPTION ACCOUNT CITY 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 CITY 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 forPLUMBING FEES: $36.26 $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 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 Bin # Qty ®f La uln ` • Building 8Z• Safety Dtvtston P.O. Box 1504, 78-495 Calle Tampico Permit # La Qutn4, CA 92253 - 760 777-7012 Building Permit Application and Traddng Sheet Projed Addtess: � t . C / 7 �T. . Owner's Name: 5 S A. P. Number Address: 75 3 � �/- Legal Description: may. ST, Zap: /UTIAZ ZS3' Contractor. —T eT 6-oe 1,--A Telephone: Address: • NeatDesmiption: Cin' sr, Zi': (of�G E !4 2236 �E T Telephone: X106 3% - #CityLia State Lia # : elk Arches Engr-, Designer. Address: t Cityy. ST, 71p: Telephone: State Lia #: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: 0 /fif ' f� / le E'- ---Sq. Ft•:. 632- # Stories: # Units: Telephone #,of Contact Pelson Estimated Value of Project 3S 6 0 0 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd ' Reed 'IAC ENG MM Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss•Cates. Called Contact Person Plan ChedkBalance Tide 24 Calcs. Plans picked up Coustg ction ' Flood plain pian Plans resubmitted Mechanical Grading plea 2` Review, ready for comccGoasRssae E16cMeal Subeoatactor List Called ContactPemon Plumbing. Groat Deed Plans picked up SAIL . $O.A: ApproVal Pians resubmitted 'Grading IN HOUSE-.,- 'ie Rje:Akw, ready for correctionsliMC Developer Impact Fee Planning Approval Called ContactPerson• AI,P p Pub. Wks. Appr Date of permit %sae Scholl Fees . i Total Permit Fees Description: GRIFFIN RANCH / BROOKS / POOL SPA BBQ AND FIRE PIT Type: POOL Subtype: Status: APPROVED Applied: 6/29/2015 SKH Approved: 6/30/2015 KKI Parcel No: 767800068 Site Address: 81735 MACBETH ST LA QUINTA,CA 92253 Subdivision: TR 32879 Block: Lot: 143 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 6/30/2015 Details: POOL, SPA, FIRE PIT, AND BBQ EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH MANUFACTURER SPECIFICATIONS. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE. _j Applied to Approved t Printed: Tuesday, June 30, 2015 4:52:49 PM 1 of 3 ��LJ LJ j■7��(V]' SYSTEMS CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES NOTE MARY FASANO 6/30/2015 CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP 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 NEWPORT CA 0 NO 1550 BEACH Printed: Tuesday, June 30, 2015 4:52:49 PM 1 of 3 ��LJ LJ j■7��(V]' SYSTEMS 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 for ELECTRICAL: $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 101-0000-42600 0 $98.62 $0.00 PC Total Paid forPOOL / SPA: $279.91 $0.00 TOTALS: $366.S1 00 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES FINAL" BLD Printed; Tuesday, June 30, 2015 4:52:49 PM 2 of 3 SYSTEMS Printed: Tuesday, June 30, 2015 4:52:49 PM 3 of 3 c , sysrr:Ms