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BPLB2016-006178-49 ALL 5 C E TAMPICO � D LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2016-0061 Owner: Property Address: 59145 SEVILLE T D DESERT DEV APN: 764700001 81570 CARBONERAS Application Description: HALEY / 50LF OF GAS LINE FOR FIRE PIT LA QUINTA, CA 0 Property Zoning: Application Valuation: $1,000.00 Applicant: TESERRA P 0 BOX 1280 COACHELLA, CA 92236 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. CSO. C29. C53, C27, D12 License No.: 656128 Dae b h/i 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).: (_)1, 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.). (_) 1, 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: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Contractor: TESERRA P 0 BOX 1280 COACHELLA, CA 92236 (760)389-9222 Llc. No.: 656128 Date: 4/6/2016 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. /%ADZ 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 witthos provisions. Date: L) , //6 Applicant: is 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 1 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 -men ioned property for inspection purposes. Date: 'q7 116 Signature (Applicant or Agent): co G a �w N:—L-- N c� � � z w I�Qi n 'gw 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. /%ADZ 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 witthos provisions. Date: L) , //6 Applicant: is 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 1 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 -men ioned property for inspection purposes. Date: 'q7 116 Signature (Applicant or Agent): FINANCIAL •/• DESCRIPTION ACCOUNT .. QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY, METHOD RECEIPT.# CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PERMIT ISSUANCE: $91.85 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $12.09 $0.00 3PAID 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 TOTALS:00 Description: HALEY/ SOLF OF GAS LINE FOR FIRE PIT Type: PLUMBING Subtype: Status: APPROVED Applied: 4/6/2016 SKH Approved: 4/6/2016 SKH Parcel No: 764700001 Site Address: 59145 SEVILLE LA QUINTA,CA 92253 Subdivision: TR 31681-3 Block: Lot: 166 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: 50LF OF 11/2' POLYPROPYLENE GAS PIPE FOR FIRE PIT. 2013 CALIFORNIA BUILDING CODES. ADDITIONAL SITES CHRONOLOGY CONDITIONS DESCRIPTION I ACCOUNT- I QTY I AMOUNT I PAID I PAID DATE I RECEIPT # I CHECK # I METHOD I PAID BY I CLLYD BSAS SB1473 FEE 1 101-0000-20306 1 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: Printed: Wednesday, April 06, 2016 10:24:21 AM 1 of 2 CN?WSYSTEMS _ Per it Det�al�S PERMIT NUMBER ~ -:� � Ci of La uinta BPLB2016-006.1 � Q INSPECTIONS PARENT PROJECTS REVIEWS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES DATE BOND INFORMATION ATTACHMENTS Printed: Wednesday, April 06, 2016 10:24:21 AM 2 of 2 (C)T SYSTEMS CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $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 TOTALS: $129.11 $0.00 INSPECTIONS PARENT PROJECTS REVIEWS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES DATE BOND INFORMATION ATTACHMENTS Printed: Wednesday, April 06, 2016 10:24:21 AM 2 of 2 (C)T SYSTEMS Bin # Permit # l - Project Address: S City ®f Lan urnta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet FVL L 1= Owner's Name: A. P. Number: Address: S /9,5— .s'Legal . Legal Description: City, ST, Zip:1,9WVTA 64t q2053 Contractor: tC.S e -z Telephone:f'3''�•�. �;3' s!i' <z•< - Address: �' p vE �y Project Description: City, ST, Zip: D Cp- y23� k �" I/ Telephone: '` P �� / 7 //, 2- 2 f State Lie. # : 1p S�p 2 City Lic. #; Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lie. #: Construction Type: Occupancy. Project type (circle one)- New Add'n Alter Repair Demo Name of Contact Person:—pllelc 2 Sq. Ft.: �� # Stories: # Units: Telephone #,of Contact Person: 6 �9 Estimated Value of Project: /44ro q Submittal APPLICANT: DO NOT. WRITE BELOW THIS LINE Req'd Recd 'TRACiGNG 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 2o4 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:- Review, ready for correctionsfissue Dcveloper Impact Fee Planning Approval Called Contact Person . A.I.P.P. Pub. Wks. Appr Date of permit Issue School Fees - Total Permit Fees CITY OF LA QUINTA COMMUNITY DMELO • MENT APPENDIX II: ARCHITECTURAL / LANDSCAPING IMPROVEMENTIHOUSE AND GARAGE PAINTING �I ,I REQUEST AN��Dqq AGREEMENT Date of Request:] Lot W_Tract No. • Owner/Applicant: L'-1''"� �'e Andalusia at Coral Mountain Address: 1445 45 -s-eV, I l` Local Telephone: Other Telephone: 416-76 —�vV • Architect(s), if applicable: 7-z�<,,22 Architect(s)'s Address: Architect(s)'s Telephone Number: • Contractor(s), if applicable: Contractor(s)'s Address: Contractor'(s)'s Telephone: (Attach additional sheets with name(s) of Contractors/Subcontractors, if necessary) • Description of Improvement: (Please drawings as appropriate):iL • Attachments (3 sets): Starting Date: ❑ Full construction drawings rrative description of the proposed modification and include ❑ Specifications/Dimensions ❑ Site Plan ❑ rainage Plan ❑ Landscape Plans Elevations ❑ Other (describe/list or attach additional pages as required): Estimated Completion Date: This Architectural / Landscape Improvement Request shall be accompanied by: ❑ A non-refundable fee of $400 as a processing and review fee to check the plans for conformance with the Design Review Guidelines. No fee for Garage & House Painting/Staining Applications. The check for this fee shall be paid to the ord %�ia at Coral Mountain Association. See appendix V for other fees. ❑ A security deposit to be drawn against by Master Association for any and all dire s to the Master Association including, but not limited to, the following: (1) legal expenses; (2) consulting fees; g fees; (4) recordation costs; (5) nonrefundable administrative costs (application fee); (6) costs to repair any da o the common area and/or streets maintained by the Master Association caused by the construction of the Architectura rovement; (7) any other costs directly related to and/or necessary for the supervision of the Architectural Improvement, e I as to bring the costs necessary for the Master Association to bring the Architectural Improvement into complian the Master Declaration and/or these Guidelines; and (8) payment for any Enforcement Assessment levied in accordan the Master Association's Enforcement Procedure. The check for this fee shall be paid to the order of Andalusia At Co ountain Association. This security deposit, minus Master Association's direct costs, shall be returned upon receipt of the Completion from Owner and final sign -off by Design Review Committee. ❑ All copies of plans and specifications, as enumerated in the Application Procedure, Section 4, (page 30). THE OWNER(S) UNDERSTANDS AND AGREES TO THE FOLLOWING: 1. By submission of this application, I/we have followed the Architectural / Landscape Request Procedure as specified in the Master Association's Architectural / Landscape Guidelines, beginning on page 29, including the attachment of three sets of any applicable plans, specifications, drawings, manufacturer's brochures, city building permits, signed construction regulations, and/or other descriptions as may be required by the Checklists, beginning on page 32. -37- Master Design Guidelines 1/1/2012 (Amended 4-25-13) 2. The architectural modifications will be made in strict compliance with the approved plans and specifications submitted with this application. Should any changes be required at any time during the project,.those changes must be approved by the Design Review Committee Architectural & Landscaping Approval Request Form and Agreement and noted on this application. 3. Owner shall hold the Master Association harmless from all liability related to any damage to existing residences, improvements thereon, any common area property and/or golf course, wherever located within the Andalusia at Coral Mountain subdivision, resulting from the installation/construction of this improvement or modification. Applicant shall advise Master Association office promptly upon completion of the work. 4. Any application shall be deemed incomplete, and the Design Review Committee shall disapprove, any and all plans and/or specifications submitted to it for approval if the Owner fails to deliver the required fees and security deposit referenced herein. 5. Owner shall comply with the Design Guidelines of the Andalusia at Coral Mountain Master Association, and furnish copies of these provisions to the contractor(s) engaged by Owner for the improvement. Applicant further understands that it is Owner's responsibility to ensure that his/her contractor(s) also complies with these provisions. 6. Owner shall secure proper building permits, if required by the local governmental entity. Applicant understands that the City of La Quinta may not approve any plans which have not yet been approved by the Master Association's Design Review Committee. 7. Owner shall pay the fees and deposits, as set forth in Section 5.3 of the Design Guidelines to process this Architectural Request Form, the terms of which are incorporated herein by this reference. 8. Applicant agrees to complete the Properties within ninety (90) days of the Properties Approval date, unless otherwise stated. "Properties Approval Date" is defined as the date of the letter granting Applicant approval to proceed with the Properties. "Completion" is defined as the date when the City of La Quinta has conducted its final inspection and approved the improvement(s), or, if no building permit is required, the date the Design Review Committee gives final approval. 9. Owner(s) agrees that he/she/they will be solely responsible for the maintenance of the improvement. Signatures: Owner: Date: Owner: Date: For house painting and garage refurbishing please provide the information below:: Garage/Stucco/Trim/Other I Paint Manufacturer Master Association use only) Color and number The attached request has been reviewed by the Design Review Committee and its action is: / pproved as Submitted El Approved as Amended ❑ Rejected C1 Rejected, Pen ' g Fu er Information El Refer to !!!attached comment Date: V Signature: ssoc on Design Review Com . ttee Final Inspection: ❑ Approved as submitted ❑ Disapproved (refer to the attached comments) Date: Signature: For the Association Design Review Committee -38- Master Design Guidelines 1/1/2012 (Amended 4-25-13)