BPOL2015-0058LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 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
Date:- -1 2-r215 . Contractor:''�"%1 �1°I
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
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 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 Address:
. 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:3�z�� /� Applicant:_ lNgy/rte{ %CMM
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 propert for inspection purposes. ,.
Date:`3 Zr S Signature (Applicant orAgent)!/-
78-495 CALLE TAMPICO
D "i �
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011COMMUNITY
DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/25/2015
Application Number:
BPOL2015-0058
Owner:
Property Address:
59175 SEVILLE
T D DESERT DEV
APN:
764700002
81570 CARBONERAS
Application Description:
POOL, SPA, BBQ & FIREPIT AT REAR YARD.
LA QUINTA, CA 0
Property Zoning:
Application Valuation:
$35,000.00
C',
•
�o
� 4
Applicant:
Contractor:
z
TESERRA
TESERRA
v �'
PO BOX 1280PO
BOX 1280
m o
COACHELLA; CA 92236COACHELLA,
CA 92236
SS
--#-1
(760)398-9222
Llc. No.: 656128
ma
------------=------------------------------------------------------------------��-e---
[vi
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 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
Date:- -1 2-r215 . Contractor:''�"%1 �1°I
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
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 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 Address:
. 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:3�z�� /� Applicant:_ lNgy/rte{ %CMM
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 ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned propert for inspection purposes. ,.
Date:`3 Zr S Signature (Applicant orAgent)!/-
,
Z'@2`.3. T ef'�-#�$Ys`.:ei[i9§' hi+F{, :Y, YS"a ly,�.yj S �J X�.: SFsy 8 .?'; ,'!�, k.. '."t,.", .�i,:.ib,F '',4 :�R.'��2 "\'c'"xn'3°Yi" 9::ti-kW 'a. �T .: Y �....,t' yEs=i.
; t DESCRIPTION � ,I, Sy + 4 TY 3 i5-4
,.ACCOUNT r*AMOUNT PAID
�r�., 1 . as a..:. < a�'m ' mazes. a z g4-111,11�Q F £ PAI DATE
PX�.
'BSAS SB1473 FEE, 101-0000-20306 0 $2.00 $0.00
yr c ;x�'a,.;:v..,,5,.. _; .0Amax.,::=
PAIU BY�r�.' y> ..METFIOD 4n RECEIPT�#..Y. x" .:.,
E a ke
F CHECK # 7 CLTD BY
.F1.:xt+€t-iLS dv..:sr.-q',.. xati�.2".'�:eE'a<s},,RZ, i.. -a„: vkSFA,Fm'�u. ,..�.'1.`i,•S_..:.,aw a'. m_2.�✓re:...:,..:kPS,LS•x�
m
Total Paid for BUILDINGSTANDARDS ADMINISTRATION BSA $2.00 ` $0.00
-hW.'Z'-Y Y ? T(%F .e7--, 4 SL I,?: , P FIF -
"` _DESGBIPTION
dF i 4i\.. � ,. } �v,:. ' b P. '..
gl A`CCOUNT
V' w y5
OUNTF�
y J•�Fy,". 4,56-. kF;^ !' i* .� 1
°Jv0.v,'+. 583, .y?3
DATE.
x , t ;r
_ .
BRAID
,PAID
DEVICES,FIRST, 20 ."
,101-0000-42403
0 -
$24.17
.'$0.00'
:�1 & : i";:f.�e'`^'�"�` > �S^ :'.�: '8i, Y 7 E
� s PA.,ID,FtBY
.: ,� ✓+'%' �yT'.v'.N r, .v, �T!:
T4"
xMET
hY'- 8
l.
-in,«. ,...j ..m::... 4K�tM`•
THODb,
R.i.w 'Y C"HECK'�Y#C
BS4
a:>: F
r.+ yam,
,_. ,xx
xY
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LTi-DzFM:
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Ys fa+.Eai£n+::,rie7 cY r.?E i%i 1yi , 3i'g?*tA
,.;e. x 3e ... ._. d ry a�'xt" 4 A -t , '�"
k`PACCOUNT'-
.. 5' , e:
( eiY4.,tte`s'
AMOUNT
r
A ,a.. E., , u .,, „ . z
,rgN
�, s
€
�,� 5PAID, apit,PAID
DATEa
DEVICES; FIRST.2l0 PC '
101-0000.-42600
0
$24.17
$0.00
_ nhnm'-m-' t
-.
:fi
#�'LTDPAID•BY
xCHECK'9
,.Y.CY g
Total Paid for ELECTRICAL: $48.34. $0.00
e&1
�:1�
NT"..`��
:%stil Q"T,xYF.
d`ih,F ,
:AM„Ma„�Oca N.T., �F:
3;.F-�31.-.Si
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r.w:�._.',ao
,
,. ,R€U .
u ADATE, ,
PIa�bDZ
GAS SYSTEM, 1-4.OUTLETS
-.101-0000-42401
0
$12.09
$0:00
°
.. � ,
RIM
'A,.: Ki.5
;; METHOD
aF:- F`<.!, -+v._,.;"•, x �„'�+y;
RECEIPT # , �
t?,., -.:as i"
go y. �
�z 5:::.s „�sa^I.i,::
� r.aa
:l k..�_
� k l ��. :
«' +. � .,,,„FsjFn ,.,ar.. v ..,
.,? CHECK # 3 :
.. }F, "L=•.4Ys.:t1'-_:F .... A`„ .; E.`�'o
CLTD BY
�#�14x.f.Y..,.a Sk .�Y ?F_,- ",�:H
;. .: vV } sr,. 'dig .x'srd -si '.r£r'y.
:a ..q,'�... n'M
DESCRIPTIUNK
,i:�2' fk4MR IA .i..
1-'*'..
QTY
aY'�:'':..#�Cx'5�,..:W iS.X far
%AMOUNT�EPAID
, E,f{i.,
8 A--,�Y-'.i rte` .a3,.e�
PAID.DATE,
ei R
`a,.aA000UNT. .., Y
"°8'�.a
GAS SYSTEM, 14 OUTLETS'PC,n.101-0000-42600
0
$24.17
$0.00
,'x�._�;i�kw
�PAID:BY s r: " ;J�
:' METHOD ' Ih y
w >s '� RECEIPT # q c
a s #
CLTD`BYt r
N .'
�WW, at`„nE '%?S``✓ .f. Y.
„t
.:i "G,
:CHECK
MOM
_. _.r.. �.;'.,v;
;Total,Paid forPLUMBING FEES: $36.26 $0.00
%(!'- Y34c'iZ mai
DESCRIPTION �$
�._: -_ iiYSx Y.?..X. Y
�4''AC000NT
U.zg
z TY�
&f:' 4: ia.<'?C ¢F!a:II
AMOUNT • '
48Sn-.Y�y��'NE
L,w,✓y YX`:'j"?, .i'"£,'
�.h
�'
,,..,t,�.IY.> ,,. ��.,,Y.a4si
;PAID �Y
�PAID;DATE
-'SWIMMING=;:;�'
- .101-0000-42404
0
$181.29
.$0.00
"
#.-ePOOL/SPA1
PAID BY
�i�
METHOD =
-,, Y'hE4".€y
¢
RECEIPT #
"#F'ir i'w..a`cv➢,'j"` Fa T.E
CHECK #
# ?c�;Y.
_ ...v ..dy„rFW,,.. .,R�.� Kxv ..l. ,. � x�x.
Y �E
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� s
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, DESCRIPTION g : E
'rtbt€ il�'E >�Y £ §F*.N4 4. iV'f✓(3
E> >, ACCOUNT ' i
.�, ;.✓v' S .i�.... ae', C'
AMOUNTa
tr Y q��;;aH?eYd'i',j' .ari'�'$a �C
PAID "
Y.. '.:. ,'✓ a a :s
PAID
� ,.
,
x,
I -
DATE>
A TE
SWIMMING POOL/SPA PC'
101-0000-42600.
0
$98.62-
$0.00 '
PAID BYu t:
3
METHOD
¢ham
•
'Fx. yxn.
#. �k;€
-A CFiECK�# ya
CLTD BYE
TotafPaid forPOOL / SPA $279.91 $0.00 .
•$3 5 $0.00
Description: POOL; SPA, BBQ & FIREPIT AT REAR YARD.
Type: POOL Subtype: Status: APPROVED
Applied: 3/25/2015 JFU
Approved: 3/25/2015 JFU
Parcel No: 764700002 Site Address: 59175 SEVILLE LA QUINTA,CA 92253
Subdivision: TR 31681-3 r Block: Lot: 167
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
JAKE FUSON
Details: POOL, SPA, BBQ AND FIRE PIT AT REAR YARD [DENISE POELTLER ENGINEERING] THIS PERMIT DOES NOT INCLUDE EQUIPMENT
ENCLOSURE. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE.
Printed: Wednesday, March 25, 2015 4:24:19 PM 1 of 3
SYSTfiviS
ADDITIONAL
CHRONOLOGY TYPE
STAFF NAME
CHRONOLOGY
ACTION DATE
COMPLETION DATE
NOTES
TELEPHONE CALL
JAKE FUSON
3/25/2015
3/25/2015
NOTIFIED MOISES W/ TESERRA PLANS WERE APPROVED AND
PERMIT WAS READY TO. ISSUE.
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
T D DESERT DEV
81570 CARBONERAS
LA QUINTA CA
0
Printed: Wednesday, March 25, 2015 4:24:19 PM 1 of 3
SYSTfiviS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE :
:RECEIPT #
CHECK #
METHOD
PAID BY
C LTD
. _
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
OUTLETS
.$0.00
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:00
INSPECTIONS
SEQID INSPECTION TYPE_' INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
FINAL" BLD
Printed: Wednesday, March 25, 2015 4:24:19 PM 2 of 3 sysrEMS
Printed: Wednesday, March 25, 2015 4:24:19 PM 3 of 3
SYSTC•titS
Qin #
Permit #
��- v'
Project Address: S /-757
0 ty of La Quin to r
Building 8r Safety Division
P.O. Boz 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
5 EV/ LC Owner's Name: �R �S. �ivs'T eU CT/awl
A. P. Number:
Address: SIM— t (—L 125 -
Legal Description:
City, ST, Zip:
Contractor: / CSE2{Z4{^•<''':ssM<':'4:a'
Telephone:
;2:>:
Address: S6161) eve-- S -t
Project Description: Pot,/ �.
City, ST, Zip: l�a9-G L
27,3
/ T
Telephone:
,:.:. N.s, .. .:4 .
State Lic.
City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
•
.
Telephone:
P
�•}':bi;4i;r•isiv4�•'r::itifir�':S{:.:y:<4•;L!i+f:4'f.!
iiN/•tl:i.4:n :S\:.ii/yy{.fvA/!m:
�4.r•>-n-fi:..>.>.�::::�:•.�.:<. ;.�.,•�•:•
fv.:fl�C;�C:•
•,:::�: ••:-�z: ,.u<.,!�-!2v: ?jti.
k`:sf . r
Construction Type: Occupancy:
State Lic. #:
Project type (circle one):C�ieJv Add'n Alter Repair Demo
Name of Contact Person: 4,lo If ET
Sq. Ft.: 3 9
# Stories:
#{ Units:
Telephone #,of Contact Person:
Estimated Value of Project: 3 S Uo0
APPLICANT: DO NOT. WRITE 13ELOW THIS LINE
# Submittal Req'd Recd TRACMG PERMIT FEES
Plan Sets
Plan Check submitted
3 2�
Item
Amount
Structural Calcs.
Reviewed, ready for corre l/
l
Ian Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" 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
1N HOUSE:
'^' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees